Provider Demographics
NPI:1609188937
Name:LEVENSON, MARVIN WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:WALTER
Last Name:LEVENSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 PACIFIC HWY
Mailing Address - Street 2:2206
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-3327
Mailing Address - Country:US
Mailing Address - Phone:619-236-1038
Mailing Address - Fax:
Practice Address - Street 1:2227 ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029
Practice Address - Country:US
Practice Address - Phone:760-480-7987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14469171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator