Provider Demographics
NPI:1720028533
Name:LEVITZ, INESA (MD)
Entity Type:Individual
Prefix:
First Name:INESA
Middle Name:
Last Name:LEVITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INESA
Other - Middle Name:
Other - Last Name:JUZVIK-LEVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 970809
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-0809
Mailing Address - Country:US
Mailing Address - Phone:808-664-1104
Mailing Address - Fax:866-592-3149
Practice Address - Street 1:94-229 WAIPAHU DEPOT ST
Practice Address - Street 2:SUITE 402
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3031
Practice Address - Country:US
Practice Address - Phone:808-676-1192
Practice Address - Fax:808-676-1193
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2011-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG84134Medicare UPIN