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General NPI Number Information
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NPI Number | 1134317308
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Entity Type | Organization
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Legal Business Name | LEWIT WORRELL MD INC
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 1334 W COVINA BLVD SUITE 101
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City | SAN DIMAS
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State | CA
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Zip | 91773-3211
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Country | US
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Telephone | 909-599-6611
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Fax | 909-599-8390
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Provider Business Mailing Address
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Address Line | PO BOX 2728
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City | COVINA
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State | CA
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Zip | 91722-8728
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Country | US
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Telephone | 909-730-4261
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEWIT A WORRELL
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Credential | M.D.
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Telephone | 909-730-4261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | A67787
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License Number State | CA
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