Healthcare Provider Details

I. General information

NPI: 1609199918
Provider Name (Legal Business Name): RANDELL TERRELL LEWIS MHRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 17TH ST STE B
OAKLAND CA
94612-4124
US

IV. Provider business mailing address

280 17TH ST
OAKLAND CA
94612-4124
US

V. Phone/Fax

Practice location:
  • Phone: 510-238-5020
  • Fax:
Mailing address:
  • Phone: 510-238-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: