Provider Demographics
NPI:1619853348
Name:LEVENZON, ALEKSANDR (CPSS)
Entity type:Individual
Prefix:
First Name:ALEKSANDR
Middle Name:
Last Name:LEVENZON
Suffix:
Gender:M
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5473 KEARNY VILLA RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1142
Mailing Address - Country:US
Mailing Address - Phone:858-394-6379
Mailing Address - Fax:
Practice Address - Street 1:8737 LAKE MURRAY BLVD UNIT 3
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-2749
Practice Address - Country:US
Practice Address - Phone:858-394-6379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-15
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPSS-SHFUET175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist