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General NPI Number Information
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NPI Number | 1326834391
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Entity Type | Individual
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Provider Name | EBONY LEWIS
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Gender | Female
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Dates
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Enumeration Date | 04/16/2025
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 3609 10TH AVE
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City | LOS ANGELES
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State | CA
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Zip | 90018-4114
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Country | US
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Telephone | 323-298-3680
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Fax | 213-402-3551
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Provider Business Mailing Address
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Address Line | 3609 10TH AVE
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City | LOS ANGELES
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State | CA
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Zip | 90018-4114
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Country | US
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Telephone | 323-298-3680
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Fax | 213-402-3551
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-ZSPFMN
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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