Provider Demographics
NPI:1053551622
Name:LEVI, MARK ANTHONY (AA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:LEVI
Suffix:
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 W 82ND ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-1232
Mailing Address - Country:US
Mailing Address - Phone:323-750-5033
Mailing Address - Fax:
Practice Address - Street 1:3411 W 82ND ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-1232
Practice Address - Country:US
Practice Address - Phone:323-750-5033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator