Provider Demographics
NPI:1720255185
Name:LEVIYEV, ISABELLA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ISABELLA
Middle Name:
Last Name:LEVIYEV
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1839 S ALMA SCHOOL RD STE 354
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-3028
Mailing Address - Country:US
Mailing Address - Phone:480-726-2287
Mailing Address - Fax:888-503-3312
Practice Address - Street 1:20860 N TATUM BLVD STE 290
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-4282
Practice Address - Country:US
Practice Address - Phone:480-563-1144
Practice Address - Fax:480-563-2371
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7939960001332B00000X
AZ7047150001332B00000X
AZ7034950001332B00000X
AZ7046960001332B00000X
AZ7045160001332B00000X
AZ7209350001332B00000X
AZ7629170001332B00000X
AZ7057360001332B00000X
AZ6045363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant