Healthcare Provider Details

I. General information

NPI: 1750295788
Provider Name (Legal Business Name): ASHLEY SUSAN LEWIS
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 AGNES AVE
SANTA MARIA CA
93458-2838
US

IV. Provider business mailing address

116 AGNES AVE
SANTA MARIA CA
93458-2838
US

V. Phone/Fax

Practice location:
  • Phone: 805-212-7680
  • Fax:
Mailing address:
  • Phone: 805-212-7680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number34520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: