Healthcare Provider Details

I. General information

NPI: 1841630266
Provider Name (Legal Business Name): MARI ELIZABETH LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARI ELIZABETH EILAND MD

II. Dates (important events)

Enumeration Date: 06/29/2013
Last Update Date: 03/10/2024
Certification Date: 03/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 QUALITY DR STE A-10
VACAVILLE CA
95688-9494
US

IV. Provider business mailing address

1 QUALITY DR STE A-10
VACAVILLE CA
95688-9494
US

V. Phone/Fax

Practice location:
  • Phone: 707-624-4300
  • Fax:
Mailing address:
  • Phone: 707-624-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26695
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number143654
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT-2666
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: