Healthcare Provider Details

I. General information

NPI: 1457543894
Provider Name (Legal Business Name): DR. MEARLE DAVID LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BARRINGTON WALK
LOS ANGELES CA
90049-2931
US

IV. Provider business mailing address

PO BOX 6150
MALIBU CA
90264
US

V. Phone/Fax

Practice location:
  • Phone: 310-589-1600
  • Fax: 310-589-1607
Mailing address:
  • Phone: 310-589-1600
  • Fax: 310-589-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberC39057
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberC39057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: