MEDICARE: LATOYIA LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1134943889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATOYIA LEWIS

Provider Business Mailing Address
First Line	:	6642 PHELAN BLVD
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77706-5966
Country	:	US
Telephone Number	:	409-242-1559
Fax Number	:

Provider Business Practice Location Address
First Line	:	6642 PHELAN BLVD
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77706-5966
Country	:	US
Telephone Number	:	409-242-1559
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	11/11/2024

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Directions to “ LATOYIA LEWIS ” Practice Location

Language	Start Address	Practice Location

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