Provider Demographics
NPI:1588497275
Name:LEVITT, LOIS JACQUELINE
Entity type:Individual
Prefix:MS
First Name:LOIS
Middle Name:JACQUELINE
Last Name:LEVITT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17400 ARROW BLVD APT 41
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-3982
Mailing Address - Country:US
Mailing Address - Phone:904-485-9223
Mailing Address - Fax:
Practice Address - Street 1:17400 ARROW BLVD APT 41
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3982
Practice Address - Country:US
Practice Address - Phone:909-803-1059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker