Provider Demographics
NPI:1558588129
Name:LEWIS, RONEL LEE (MD)
Entity Type:Individual
Prefix:
First Name:RONEL
Middle Name:LEE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
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 1613
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-6613
Mailing Address - Country:US
Mailing Address - Phone:925-648-4800
Mailing Address - Fax:925-648-2530
Practice Address - Street 1:4185 BLACKHAWK PLAZA CIR
Practice Address - Street 2:SUITE 210
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4694
Practice Address - Country:US
Practice Address - Phone:925-648-4800
Practice Address - Fax:925-648-2530
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC328212084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA13399 & 838OtherBOARD CERTIFIED CHADOLADT
CAC32821OtherSTATE LICENSE
CAC32821OtherSTATE LICENSE