Provider Demographics
NPI:1407883127
Name:LEWIS, CHRIS E
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
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 232410
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92193-2410
Mailing Address - Country:US
Mailing Address - Phone:760-598-1700
Mailing Address - Fax:
Practice Address - Street 1:910 SYCAMORE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-7832
Practice Address - Country:US
Practice Address - Phone:760-598-1700
Practice Address - Fax:760-598-1196
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12999363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA129990Medicaid
CA0PA129990Medicaid
CAWPA12999EMedicare PIN
CA4112180001Medicare NSC