Healthcare Provider Details

I. General information

NPI: 1013934553
Provider Name (Legal Business Name): PAUL J LEWANDOWSKI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 NIELSON ST EM DEPT
WATSONVILLE CA
95076-2468
US

IV. Provider business mailing address

2100 POWELL ST STE 900
EMERYVILLE CA
94608-1844
US

V. Phone/Fax

Practice location:
  • Phone: 831-761-5613
  • Fax: 831-761-5667
Mailing address:
  • Phone: 510-350-2673
  • Fax: 510-879-4084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA16348
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: