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NPI Code Detail

MEDICARE: DR. JACKLYN ELIZABETH LEWIS PH.D.

MEDICARE: DR. JACKLYN ELIZABETH LEWIS PH.D.
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
1103TC0700XClinical PsychologistPSY14269CA

General Provider Information

NPI Number : 1982769253
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACKLYN ELIZABETH LEWIS PH.D.
Provider Business Mailing Address
First Line : 23 CORPORATE PLAZA DR STE 150
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-7908
Country : US
Telephone Number : 714-962-2073
Fax Number :
Provider Business Practice Location Address
First Line : 23 CORPORATE PLAZA DR STE 150
Second Line :
City : NEWPORT BEACH
State : CA
Zip : 92660-7908
Country : US
Telephone Number : 714-962-2073
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2006
Last Update Date : 07/09/2012

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