Provider Demographics
NPI:1912075961
Name:LEVENIEC, EMIL (DPM)
Entity Type:Individual
Prefix:DR
First Name:EMIL
Middle Name:
Last Name:LEVENIEC
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:EMIL
Other - Middle Name:
Other - Last Name:LEVENIEC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:6311 TARRAGON RD
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-5834
Mailing Address - Country:US
Mailing Address - Phone:310-377-2310
Mailing Address - Fax:
Practice Address - Street 1:6311 TARRAGON RD
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-5834
Practice Address - Country:US
Practice Address - Phone:310-377-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1317213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1317DMedicare ID - Type UnspecifiedPODIATRY