MEDICARE: MRS. ALEXANDRA LOPEZ LEWIS MPAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA 9100654	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194719609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALEXANDRA LOPEZ LEWIS MPAS

Provider Business Mailing Address
First Line	:	401 W LANTANA RD
Second Line	:	SUITE #4
City	:	LANTANA
State	:	FL
Zip	:	33462-1725
Country	:	US
Telephone Number	:	561-588-0015
Fax Number	:	561-586-9048

Provider Business Practice Location Address
First Line	:	401 W LANTANA RD
Second Line	:	SUITE #4
City	:	LANTANA
State	:	FL
Zip	:	33462-1725
Country	:	US
Telephone Number	:	561-588-0015
Fax Number	:	561-586-9048

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	07/27/2009

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