Provider Demographics
NPI:1457598385
Name:MARIA LEVISTE MD INC.
Entity Type:Organization
Organization Name:MARIA LEVISTE MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVISTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-783-9005
Mailing Address - Street 1:6150 PASEO LA VIS
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-1082
Mailing Address - Country:US
Mailing Address - Phone:818-783-9005
Mailing Address - Fax:818-932-9936
Practice Address - Street 1:1101 N PACIFIC AVE
Practice Address - Street 2:SUITE #103
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-3250
Practice Address - Country:US
Practice Address - Phone:818-783-9005
Practice Address - Fax:818-932-9936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA39016AMedicare UPIN