# BRUCE D. LEVINE, D.P.M., PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BRUCE D. LEVINE, D.P.M., PROFESSIONAL CORPORATION
- **Other names:** Harbor Foot & Ankle Podiatric Medical Group
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1891176616
- **Legal business name:** BRUCE D. LEVINE, D.P.M., PROFESSIONAL CORPORATION
- **Authorized official:** BRUCE D. LEVINE DPM (OWNER)
- **Authorized official phone:** (310) 548-1191

## Contact information

- **Practice address:** 1360 W 6TH ST, SUITE 150, WEST BUILDING, SAN PEDRO, CA 90732-3514
- **Practice address phone:** (310) 548-1191
- **Mailing address:** 2980 N BEVERLY GLEN CIR, SUITE 100, LOS ANGELES, CA 90077-1726
- **Mailing address phone:** (310) 943-4180
- **Mailing address fax:** (888) 431-8819

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | E3485 | CA | Yes |

## Other

- **Enumeration date:** 06/17/2015
- **Last updated:** 10/05/2015