Provider Demographics
NPI:1699700518
Name:LEVY, LESLIE G (DPM)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:G
Last Name:LEVY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23501 CINEMA DR.
Mailing Address - Street 2:209
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355
Mailing Address - Country:US
Mailing Address - Phone:661-254-0795
Mailing Address - Fax:661-254-8762
Practice Address - Street 1:23501 CINEMA DRIVE
Practice Address - Street 2:#209
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-2058
Practice Address - Country:US
Practice Address - Phone:661-254-0795
Practice Address - Fax:661-254-8762
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2448213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6592950001OtherMEDICARE NSC
CA000E24480Medicaid
CA000E24481Medicaid
CAT11334Medicare UPIN
CAE2448AMedicare ID - Type UnspecifiedHAS ANOTHER OFFICE
CA000E24481Medicaid