Provider Demographics
NPI:1063674992
Name:LEWIS, STEVEN EDWARD (PAC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:EDWARD
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2422
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90267-2422
Mailing Address - Country:US
Mailing Address - Phone:310-971-3600
Mailing Address - Fax:
Practice Address - Street 1:740 S OLIVE ST STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90014-2616
Practice Address - Country:US
Practice Address - Phone:310-971-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2021-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19772363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant