Basic Information
| Provider Information | |||||||||
| NPI: | 1255399523 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVINSON | ||||||||
| FirstName: | GARY | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 VIA DE LA VALLE | ||||||||
| Address2: | SUITE #200 | ||||||||
| City: | DEL MAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920141992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992708 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2600 VIA DE LA VALLE | ||||||||
| Address2: | SUITE #200 | ||||||||
| City: | DEL MAR | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920141992 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8584992708 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 07/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A049820 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.