Provider Demographics
NPI:1396936381
Name:DR. DAVID R. LEVIN
Entity type:Organization
Organization Name:DR. DAVID R. LEVIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:REECE
Authorized Official - Last Name:LEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-363-1120
Mailing Address - Street 1:30011 IVY GLENN DR STE 107
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5015
Mailing Address - Country:US
Mailing Address - Phone:949-363-1120
Mailing Address - Fax:
Practice Address - Street 1:30011 IVY GLENN DR STE 107
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-5015
Practice Address - Country:US
Practice Address - Phone:949-363-1120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWE10818Medicare PIN