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1972780575 NPI number — CHARLES LEWIS MD PROFESSIONAL CORPORATION

NPI Number: 1972780575
Health Care Provider/Practitioner: CHARLES LEWIS MD PROFESSIONAL CORPORATION

Information about “1972780575” NPI (CHARLES LEWIS MD PROFESSIONAL CORPORATION) exists in 1972780575 in HTML format HTML  |  1972780575 in plain Text format TXT  |  1972780575 in PDF (Portable Document Format) PDF  |  1972780575 in an XML format XML  formats.

NPI Number : 1972780575 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972780575",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CHARLES LEWIS MD PROFESSIONAL CORPORATION",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8318 UNIVERSITY AVE",
    "SecondLineMailingAddress": "SUITE A5",
    "MailingAddressCityName": "LA MESA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "91942-9358",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "619-579-2187",
    "MailingAddressFaxNumber": "619-579-2187",
    "FirstLinePracticeLocationAddress": "8318 UNIVERSITY AVE",
    "SecondLinePracticeLocationAddress": "SUITE A5",
    "PracticeLocationAddressCityName": "LA MESA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "91942-3865",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "619-579-2187",
    "PracticeLocationAddressFaxNumber": "619-579-2187",
    "EnumerationDate": "01/25/2008",
    "LastUpdateDate": "11/03/2014",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "SHELL",
    "AuthorizedOfficialFirstName": "STEPHANIE",
    "AuthorizedOfficialMiddleName": "E",
    "AuthorizedOfficialTitle": "BILLING AGENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "760-539-7700",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "1041C0700X",
          "TaxonomyName": "Clinical Social Worker",
          "LicenseNumber": "LCS9115",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2084P0800X",
          "TaxonomyName": "Psychiatry Physician",
          "LicenseNumber": "C33286",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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