Provider Demographics
NPI:1235521295
Name:LEWIS, MALIA PATICIA JEAN (LMP)
Entity Type:Individual
Prefix:
First Name:MALIA
Middle Name:PATICIA JEAN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33040 22ND PL S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6856
Mailing Address - Country:US
Mailing Address - Phone:206-793-2355
Mailing Address - Fax:
Practice Address - Street 1:530 S 336TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6383
Practice Address - Country:US
Practice Address - Phone:253-874-3857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-28
Last Update Date:2015-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60404048174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist