Provider Demographics
NPI:1659418762
Name:LEVENSTEIN, JEANNETTE J (MD)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:J
Last Name:LEVENSTEIN
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 1:16550 VENTURA BLVD
Mailing Address - Street 2:STE 414
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2004
Mailing Address - Country:US
Mailing Address - Phone:818-783-3110
Mailing Address - Fax:818-783-3115
Practice Address - Street 1:16550 VENTURA BLVD
Practice Address - Street 2:STE 414
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2004
Practice Address - Country:US
Practice Address - Phone:818-783-3110
Practice Address - Fax:818-783-3115
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75081208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG75081OtherMEDICAL LICENSE #