Provider Demographics
NPI:1417160961
Name:LEVY, TARA LYNN (ND)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LYNN
Last Name:LEVY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 GRAND AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1077
Mailing Address - Country:US
Mailing Address - Phone:925-949-8604
Mailing Address - Fax:925-949-8436
Practice Address - Street 1:1375 GRAND AVE STE 202
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94610-1077
Practice Address - Country:US
Practice Address - Phone:925-949-8604
Practice Address - Fax:925-949-8436
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-18175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath