Basic Information
| Provider Information | |||||||||
| NPI: | 1326467366 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVY | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2696 W SAN JOSE AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937112734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5596961010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 399 TAYLOR BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945232287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9252703575 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2014 | ||||||||
| LastUpdateDate: | 12/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | A139474 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.