Provider Demographics
NPI:1629302500
Name:MARK DAVID LEVINE, MD, REDDING PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARK DAVID LEVINE, MD, REDDING PROFESSIONAL CORPORATION
Other - Org Name:COMMUNITY PSYCHIATRY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-576-7898
Mailing Address - Street 1:2081 ARENA BLVD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2309
Mailing Address - Country:US
Mailing Address - Phone:916-576-7898
Mailing Address - Fax:916-285-0338
Practice Address - Street 1:3 GOVERNORS LN
Practice Address - Street 2:SUITE D
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-5503
Practice Address - Country:US
Practice Address - Phone:530-838-4188
Practice Address - Fax:530-838-4394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty