Healthcare Provider Details

I. General information

NPI: 1225908247
Provider Name (Legal Business Name): TENESHA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 11/07/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25961 GLEN SUMMER DR
LOMA LINDA CA
92354-6529
US

IV. Provider business mailing address

25961 GLEN SUMMER DR
LOMA LINDA CA
92354-6529
US

V. Phone/Fax

Practice location:
  • Phone: 909-224-6790
  • Fax:
Mailing address:
  • Phone: 909-224-6790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: