Provider Demographics
NPI:1477714020
Name:LEWIS, LINDA A (PA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5260 S FIGUEROA ST
Mailing Address - Street 2:110
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-3743
Mailing Address - Country:US
Mailing Address - Phone:323-230-7453
Mailing Address - Fax:323-230-8584
Practice Address - Street 1:5260 S FIGUEROA ST
Practice Address - Street 2:110
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-3743
Practice Address - Country:US
Practice Address - Phone:323-230-7453
Practice Address - Fax:323-230-8584
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA10179363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA10179OtherPHYSICIAN ASSISTANT COMMITTEE, MEDICAL BOARD OF CALIFORNIA