Healthcare Provider Details

I. General information

NPI: 1588973523
Provider Name (Legal Business Name): MICHELLE YVONNE LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 N STATE ST
SAN JACINTO CA
92583-6573
US

IV. Provider business mailing address

1695 N SUNRISE WAY
PALM SPRINGS CA
92262-3701
US

V. Phone/Fax

Practice location:
  • Phone: 951-487-8506
  • Fax:
Mailing address:
  • Phone: 760-323-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA112253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: