Provider Demographics
NPI:1164010492
Name:LEWIS GAMARRA MD PC
Entity Type:Organization
Organization Name:LEWIS GAMARRA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:EDGAR
Authorized Official - Last Name:GAMARRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-471-4397
Mailing Address - Street 1:2115 10TH ST STE A2
Mailing Address - Street 2:
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-3244
Mailing Address - Country:US
Mailing Address - Phone:805-534-9360
Mailing Address - Fax:805-534-9345
Practice Address - Street 1:2115 10TH ST STE A2
Practice Address - Street 2:
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-3244
Practice Address - Country:US
Practice Address - Phone:805-534-9360
Practice Address - Fax:805-534-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-03
Last Update Date:2021-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care