Provider Demographics
NPI:1487045316
Name:LEWIS-DE LOS ANGELES, CHRISTINE PAULA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE PAULA
Middle Name:
Last Name:LEWIS-DE LOS ANGELES
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RHODE ISLAND HOSPITAL
Mailing Address - Street 2:593 EDDY STREET
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903
Mailing Address - Country:US
Mailing Address - Phone:401-444-3762
Mailing Address - Fax:401-444-8879
Practice Address - Street 1:RHODE ISLAND HOSPITAL
Practice Address - Street 2:593 EDDY STREET
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-444-3762
Practice Address - Fax:401-444-8879
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-13
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
RILP045612084P0804X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry