MEDICARE: DANICA RENEE LEWIS

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	103G00000X	Clinical Neuropsychologist

General Provider Information

NPI Number	:	1538098058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANICA RENEE LEWIS

Provider Business Mailing Address
First Line	:	9502 CATTARAUGUS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-2322
Country	:	US
Telephone Number	:	310-728-9779
Fax Number	:

Provider Business Practice Location Address
First Line	:	9502 CATTARAUGUS AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-2322
Country	:	US
Telephone Number	:	310-728-9779
Fax Number	:

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

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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