Provider Demographics
NPI:1730339532
Name:LEVITT, ELLENL (LM)
Entity type:Individual
Prefix:MRS
First Name:ELLENL
Middle Name:
Last Name:LEVITT
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1539 CENTRAL AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6932
Mailing Address - Country:US
Mailing Address - Phone:510-459-8708
Mailing Address - Fax:
Practice Address - Street 1:1539 CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6932
Practice Address - Country:US
Practice Address - Phone:510-459-8708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM0007176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife