MEDICARE: RAUQUEL MARIE 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1366385312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAUQUEL MARIE LEWIS

Provider Business Mailing Address
First Line	:	4709 LAGUNA WEST WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-5133
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4709 LAGUNA WEST WAY
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-5133
Country	:	US
Telephone Number	:	628-234-4272
Fax Number	:

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

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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Directions to “ RAUQUEL MARIE LEWIS ” Practice Location

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