Healthcare Provider Details

I. General information

NPI: 1477163046
Provider Name (Legal Business Name): PIONEERS MEMORIAL HEALTHCARE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2020
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 W LEGION RD STE 204
BRAWLEY CA
92227-7755
US

IV. Provider business mailing address

751 W LEGION RD STE 204
BRAWLEY CA
92227-7755
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-2626
  • Fax: 760-351-2616
Mailing address:
  • Phone: 760-351-2626
  • Fax: 760-351-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE EDWARD LEWIS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 760-351-3597