Provider Demographics
NPI:1992736904
Name:LEVANDER, ERIC M (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:LEVANDER
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 1:9009 BEVERLY BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-2424
Mailing Address - Country:US
Mailing Address - Phone:310-499-4644
Mailing Address - Fax:319-499-4699
Practice Address - Street 1:9009 BEVERLY BLVD STE 105
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-2424
Practice Address - Country:US
Practice Address - Phone:310-499-4644
Practice Address - Fax:310-499-4699
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA729682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A729680Medicaid
CA00A729680Medicaid