Provider Demographics
NPI:1093361552
Name:LEWIS, LYNSI (DAMC, LAC)
Entity Type:Individual
Prefix:
First Name:LYNSI
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DAMC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 W POINT LOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-1427
Mailing Address - Country:US
Mailing Address - Phone:334-406-8290
Mailing Address - Fax:
Practice Address - Street 1:4666 CASS ST STE A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2860
Practice Address - Country:US
Practice Address - Phone:619-761-9544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18426171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist