Basic Information
| Provider Information | |||||||||
| NPI: | 1952350381 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVENBERG | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5300 SNYDER LN | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ROHNERT PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949282915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075858347 | ||||||||
| FaxNumber: | 7075858056 | ||||||||
| Practice Location | |||||||||
| Address1: | 5300 SNYDER LN | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ROHNERT PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 949282915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075858347 | ||||||||
| FaxNumber: | 7075858056 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 11/21/2014 | ||||||||
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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 | 207Q00000X | 20A5003 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 020A50030 | 05 | CA | MEDICAID |