Provider Demographics
NPI:1063413110
Name:LEVINE, BRETT A (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:A
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21320 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-5606
Mailing Address - Country:US
Mailing Address - Phone:310-540-2111
Mailing Address - Fax:310-944-9295
Practice Address - Street 1:21320 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 119
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5606
Practice Address - Country:US
Practice Address - Phone:310-543-2313
Practice Address - Fax:310-944-9295
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2012-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG74806207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G748060Medicaid
CA00G748060Medicaid
CAWG74806AMedicare PIN