Provider Demographics
NPI:1720155807
Name:HERRELLA, LEVITA (MD)
Entity Type:Individual
Prefix:
First Name:LEVITA
Middle Name:
Last Name:HERRELLA
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 1:658 S SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3504
Mailing Address - Country:US
Mailing Address - Phone:323-937-4383
Mailing Address - Fax:323-937-4383
Practice Address - Street 1:531 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2315
Practice Address - Country:US
Practice Address - Phone:213-624-8411
Practice Address - Fax:213-624-8411
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34276207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A342760Medicaid
CAA34276Medicare PIN
CABM296ZMedicare PIN
CA00A342760Medicaid