Healthcare Provider Details

I. General information

NPI: 1760609721
Provider Name (Legal Business Name): BEVERLY J LEW MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 W ALAMEDA AVE STE 101
BURBANK CA
91505-4338
US

IV. Provider business mailing address

4001 W ALAMEDA AVE STE 101
BURBANK CA
91505-4338
US

V. Phone/Fax

Practice location:
  • Phone: 818-841-0066
  • Fax: 818-841-2141
Mailing address:
  • Phone: 818-841-0066
  • Fax: 818-841-2141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU1187 & HA2614
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: