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General NPI Number Information
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NPI Number | 1700343043
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Entity Type | Individual
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Provider Name | MATILDE LIDIA LEWIS RN
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Gender | Female
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Dates
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Enumeration Date | 02/22/2019
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Last Update Date | 02/22/2019
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Provider Practice Location Address
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Address Line | 9915 NW 41 ST SUITE 230
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City | DORAL
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State | FL
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Zip | 33178
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Country | US
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Telephone | 786-595-9900
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Fax | 786-533-9475
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Provider Business Mailing Address
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Address Line | 9915 NW 41 ST SUITE 230
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City | DORAL
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State | FL
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Zip | 33178
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Country | US
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Telephone | 786-595-9900
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Fax | 786-533-9475
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | CDE09910404
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN2508122
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License Number State | FL
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