Healthcare Provider Details

I. General information

NPI: 1134317308
Provider Name (Legal Business Name): LEWIT WORRELL MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2007
Last Update Date: 07/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1334 W COVINA BLVD SUITE 101
SAN DIMAS CA
91773-3211
US

IV. Provider business mailing address

PO BOX 2728
COVINA CA
91722-8728
US

V. Phone/Fax

Practice location:
  • Phone: 909-599-6611
  • Fax: 909-599-8390
Mailing address:
  • Phone: 909-730-4261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA67787
License Number StateCA

VIII. Authorized Official

Name: DR. LEWIT A WORRELL
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-730-4261