Individual
JEREMY ETHAN LEVENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2125 ARIZONA AVE, SANTA MONICA, CA 90404-1337
(310) 829-8701
(310) 315-4062
Mailing address
6654 KENTWOOD BLUFFS DR, LOS ANGELES, CA 90045-1259
(310) 216-4476
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
A22502
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A225020
—
CA
01
—
P00178725
RAILROAD MEDICARE
CA
Enumeration date
07/07/2006
Last updated
04/16/2021
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