Healthcare Provider Details

I. General information

NPI: 1811045156
Provider Name (Legal Business Name): DR. SUZAN M. LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 01/06/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL HOSPITAL BUILDING H-100 SANTA MARGARITA ROAD
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

PO BOX 741331
ATLANTA GA
30374-1331
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1400
  • Fax: 760-725-1267
Mailing address:
  • Phone: 913-469-0503
  • Fax: 913-469-5267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number05-35689
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: