Provider Demographics
NPI:1568541274
Name:LEVENS, TRACEY (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:
Last Name:LEVENS
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 1:4817 CENTENNIAL PLAZA WAY # B
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-1957
Mailing Address - Country:US
Mailing Address - Phone:661-213-3300
Mailing Address - Fax:661-213-3330
Practice Address - Street 1:4817 CENTENNIAL PLAZA WAY # B
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-1957
Practice Address - Country:US
Practice Address - Phone:661-213-3300
Practice Address - Fax:661-213-3330
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86419207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG39730Medicare UPIN
CAZZZ18954ZMedicare ID - Type Unspecified