Provider Demographics
NPI:1417718313
Name:LEWIS, TRAVIS (NUTRITION COACH)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:NUTRITION COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25632 CROWN VALLEY PKWY STE B-4
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0472
Mailing Address - Country:US
Mailing Address - Phone:949-503-1807
Mailing Address - Fax:
Practice Address - Street 1:25632 CROWN VALLEY PKWY STE B-4
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0472
Practice Address - Country:US
Practice Address - Phone:949-503-1807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach