Provider Demographics
NPI:1144820002
Name:PARA, LEVI (SOIDC)
Entity type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:PARA
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 W MCMANAMON RD
Mailing Address - Street 2:
Mailing Address - City:OTHELLO
Mailing Address - State:WA
Mailing Address - Zip Code:99344-9027
Mailing Address - Country:US
Mailing Address - Phone:509-308-0864
Mailing Address - Fax:
Practice Address - Street 1:2D RECONNAISSANCE BN
Practice Address - Street 2:PSC 20138
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28452-0138
Practice Address - Country:US
Practice Address - Phone:910-440-7703
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman