Provider Demographics
NPI:1841225950
Name:LEVINE, STEVEN JAY (MD FACC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JAY
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SANTA MONICA BLVD
Mailing Address - Street 2:STE 687 WEST
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2102
Mailing Address - Country:US
Mailing Address - Phone:310-829-3350
Mailing Address - Fax:310-829-3395
Practice Address - Street 1:2001 SANTA MONICA BLVD
Practice Address - Street 2:STE 687 WEST
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2102
Practice Address - Country:US
Practice Address - Phone:310-829-3350
Practice Address - Fax:310-829-3395
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53715207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG53715Medicare ID - Type UnspecifiedMEDICARE IN OFFICE
CAHG53715Medicare ID - Type UnspecifiedMEDICARE SANTA MONICA HOS
CAHG53715AMedicare ID - Type UnspecifiedMEDICARE ST. JOHNS HOSPIT
CAB57960Medicare UPIN