Provider Demographics
NPI:1922080969
Name:LEVI, LORI ALISA (MD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:ALISA
Last Name:LEVI
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 1:51 N 5TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3739
Mailing Address - Country:US
Mailing Address - Phone:626-358-1970
Mailing Address - Fax:626-358-1971
Practice Address - Street 1:51 N 5TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3739
Practice Address - Country:US
Practice Address - Phone:626-358-1970
Practice Address - Fax:626-358-1971
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGO67252207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F90574Medicare UPIN
CAW18070Medicare ID - Type Unspecified