Provider Demographics
NPI:1497960678
Name:LOUIS LEVY JR. M.D. A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LOUIS LEVY JR. M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEVY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:619-589-6888
Mailing Address - Street 1:300 S PIERCE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4124
Mailing Address - Country:US
Mailing Address - Phone:619-589-6888
Mailing Address - Fax:619-589-6492
Practice Address - Street 1:300 S PIERCE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4124
Practice Address - Country:US
Practice Address - Phone:619-589-6888
Practice Address - Fax:619-589-6492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37491207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC374912Medicaid
CAA36642Medicare UPIN
W22373Medicare PIN
CAC37491Medicare ID - Type Unspecified