Provider Demographics
NPI:1528165263
Name:LEVY-GANTT, REBECCA (DO)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LEVY-GANTT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:LEVY-GANTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3030 BEARD RD
Mailing Address - Street 2:STE C
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3490
Mailing Address - Country:US
Mailing Address - Phone:707-681-1545
Mailing Address - Fax:
Practice Address - Street 1:3030 BEARD RD
Practice Address - Street 2:STE C
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3490
Practice Address - Country:US
Practice Address - Phone:707-681-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2014-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8707207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP724771OtherOXFORD
NY68I56OtherBLUE CROSS
NYG54340Medicare UPIN
NYP724771OtherOXFORD
NY43G43Medicare ID - Type Unspecified