Individual
GARY M. LEVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
24401 CALLE DE LA LOUISA STE 200, LAGUNA HILLS, CA 92653
(949) 452-7200
Mailing address
PO BOX 51787, LOS ANGELES, CA 90051-6087
(949) 452-7200
(949) 464-0720
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G64219
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G642190
BLUE SHIELD
CA
05
—
00G642190
—
CA
Enumeration date
06/08/2006
Last updated
08/24/2018
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