Healthcare Provider Details

I. General information

NPI: 1902124241
Provider Name (Legal Business Name): TIFFANY ROSLYN LEWIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY ROSLYN SCHEGG MD

II. Dates (important events)

Enumeration Date: 05/11/2010
Last Update Date: 01/15/2023
Certification Date: 01/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 B GALE WILSON BLVD
FAIRFIELD CA
94533-3552
US

IV. Provider business mailing address

5716 FOLSOM BLVD # 241
SACRAMENTO CA
95819-4608
US

V. Phone/Fax

Practice location:
  • Phone: 707-646-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA128528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: