Healthcare Provider Details

I. General information

NPI: 1033633672
Provider Name (Legal Business Name): MRS. SIMONE YVONNE LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS SIMONE YVONNE JACKSON

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 COYLE AVE
CARMICHAEL CA
95608-0306
US

IV. Provider business mailing address

10243 PISTACHIO WAY
SACRAMENTO CA
95827-2472
US

V. Phone/Fax

Practice location:
  • Phone: 916-537-5000
  • Fax:
Mailing address:
  • Phone: 916-617-1482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: