Healthcare Provider Details

I. General information

NPI: 1952120255
Provider Name (Legal Business Name): ILANA KATERINA LEWIS ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W JANSS RD STE 135
THOUSAND OAKS CA
91360-1857
US

IV. Provider business mailing address

200 1/2 W CYPRESS ST
GLENDALE CA
91204-2605
US

V. Phone/Fax

Practice location:
  • Phone: 805-373-2890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: