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General NPI Number Information
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NPI Number | 1760456529
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Entity Type | Individual
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Provider Name | BEVERLY LEWIS MD
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Gender | Female
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Dates
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Enumeration Date | 02/16/2006
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Last Update Date | 02/01/2021
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Provider Practice Location Address
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Address Line | 900 S MAIN ST STE 105
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City | CORONA
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State | CA
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Zip | 92882-3401
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Country | US
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Telephone | 951-363-0243
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Fax |
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Provider Business Mailing Address
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Address Line | 29306 CATALPA
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City | LAKE ELSINORE
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State | CA
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Zip | 92530-9100
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Country | US
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Telephone | 310-806-1002
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G42697
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | G42697
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License Number State | CA
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