Provider Demographics
NPI:1477501203
Name:LEVENTIS, LYNN LUCILLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:LUCILLE
Last Name:LEVENTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 PIONEER LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2517
Mailing Address - Country:US
Mailing Address - Phone:760-873-2602
Mailing Address - Fax:760-873-2750
Practice Address - Street 1:153 PIONEER LN STE B
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-2517
Practice Address - Country:US
Practice Address - Phone:760-873-2602
Practice Address - Fax:760-873-2750
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000026240207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology