Healthcare Provider Details

I. General information

NPI: 1184530263
Provider Name (Legal Business Name): MARC CRANSTON BRANDON LEWIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HEATHER AVE APT 9
SAN FRANCISCO CA
94118-2704
US

IV. Provider business mailing address

1263 MISSION ST
SAN FRANCISCO CA
94103-2705
US

V. Phone/Fax

Practice location:
  • Phone: 619-249-4227
  • Fax:
Mailing address:
  • Phone: 415-502-3000
  • Fax: 415-514-6466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: