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General NPI Number Information
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NPI Number | 1841465150
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Entity Type | Organization
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Legal Business Name | PACIFIC MEDICAL GROUP
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Dates
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Enumeration Date | 04/28/2008
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 48 N EL MOLINO AVE SUITE 201
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City | PASADENA
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State | CA
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Zip | 91101-1861
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Country | US
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Telephone | 626-796-8181
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Fax | 626-796-1874
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Provider Business Mailing Address
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Address Line | 48 N EL MOLINO AVE SUITE 201
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City | PASADENA
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State | CA
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Zip | 91101-1861
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Country | US
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Telephone | 626-796-8181
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Fax | 626-796-1874
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. NATHAN L LEWIS
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Credential | MD
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Telephone | 626-796-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | G40994
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License Number State | CA
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