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General NPI Number Information
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NPI Number | 1972780575
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Entity Type | Organization
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Legal Business Name | CHARLES LEWIS MD PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 01/25/2008
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Last Update Date | 11/03/2014
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Provider Practice Location Address
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Address Line | 8318 UNIVERSITY AVE SUITE A5
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City | LA MESA
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State | CA
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Zip | 91942-3865
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Country | US
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Telephone | 619-579-2187
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Fax | 619-579-2187
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Provider Business Mailing Address
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Address Line | 8318 UNIVERSITY AVE SUITE A5
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City | LA MESA
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State | CA
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Zip | 91942-9358
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Country | US
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Telephone | 619-579-2187
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Fax | 619-579-2187
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Authorized Official
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Title or Position | BILLING AGENT
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Name | STEPHANIE E SHELL
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Credential |
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Telephone | 760-539-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS9115
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | C33286
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License Number State | CA
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