Provider Demographics
NPI:1205207669
Name:LEWIS, VERONICA ANN (NP)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12746 W JEFFERSON BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2885
Mailing Address - Country:US
Mailing Address - Phone:310-385-3466
Mailing Address - Fax:310-385-3217
Practice Address - Street 1:12746 W JEFFERSON BLVD FL 3
Practice Address - Street 2:
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90094-2885
Practice Address - Country:US
Practice Address - Phone:424-315-2240
Practice Address - Fax:310-385-3217
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95002904363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner