Provider Demographics
NPI:1972753515
Name:SERGIO LEVENZON M.D. INC.
Entity type:Organization
Organization Name:SERGIO LEVENZON M.D. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVENZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-953-4242
Mailing Address - Street 1:520 N MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4623
Mailing Address - Country:US
Mailing Address - Phone:714-953-4242
Mailing Address - Fax:714-953-4366
Practice Address - Street 1:520 N MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4623
Practice Address - Country:US
Practice Address - Phone:714-953-4242
Practice Address - Fax:714-953-4366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30834174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty