Provider Demographics
NPI:1992725527
Name:LEVIN, ROBERT E (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 20TH ST STE 590
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2054
Mailing Address - Country:US
Mailing Address - Phone:310-315-0101
Mailing Address - Fax:
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:SUITE 590
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-315-0101
Practice Address - Fax:310-453-4145
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2010-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21065174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA952976030OtherGROUP TAX IDENTIFICATION
CA00G210650Medicaid
CAHW1249AMedicare PIN
CA00G210650Medicaid
CA952976030OtherGROUP TAX IDENTIFICATION
CAA41163Medicare UPIN
CAWG21065DMedicare PIN
CAWG21065BMedicare PIN
CAHW1249Medicare PIN