Provider Demographics
NPI:1649360595
Name:LEVIN, WENDY JO (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:JO
Last Name:LEVIN
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:PO BOX 8470
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-8470
Mailing Address - Country:US
Mailing Address - Phone:858-756-7976
Mailing Address - Fax:877-481-5208
Practice Address - Street 1:10646 SCIENCE CENTER DR
Practice Address - Street 2:CB10
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1150
Practice Address - Country:US
Practice Address - Phone:858-622-8019
Practice Address - Fax:877-481-5208
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039665207RH0003X
CAA72488207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
280200OtherINTERNAL ID-MOTOR VEHICLE ID
WA8424319Medicaid
WA8424319Medicaid
280200OtherINTERNAL ID-MOTOR VEHICLE ID