Provider Demographics
NPI:1245441302
Name:LEVITAN, KRISTIN MAURA (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MAURA
Last Name:LEVITAN
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 1:900 N SAN ANTONIO RD
Mailing Address - Street 2:#216
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1373
Mailing Address - Country:US
Mailing Address - Phone:650-917-1900
Mailing Address - Fax:650-917-1049
Practice Address - Street 1:900 N SAN ANTONIO RD
Practice Address - Street 2:#216
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1373
Practice Address - Country:US
Practice Address - Phone:650-917-1900
Practice Address - Fax:650-917-1049
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0614772084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine