Basic Information
| Provider Information | |||||||||
| NPI: | 1639540396 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK DAVID LEVINE MD NURSING SERVICES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3835 N FREEWAY BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958341928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165767898 | ||||||||
| FaxNumber: | 9162850338 | ||||||||
| Practice Location | |||||||||
| Address1: | 5776 STONERIDGE MALL RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945882832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554272778 | ||||||||
| FaxNumber: | 9162850338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2015 | ||||||||
| LastUpdateDate: | 10/07/2015 | ||||||||
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| AuthorizedOfficialLastName: | LEVINE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9165767898 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0808X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
No ID Information.