Provider Demographics
NPI:1578863452
Name:LEWIS, RICHARD C (RT)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:C
Last Name:LEWIS
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 MCKINLEY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6806
Mailing Address - Country:US
Mailing Address - Phone:408-625-0418
Mailing Address - Fax:
Practice Address - Street 1:3069 MCKINLEY DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-6806
Practice Address - Country:US
Practice Address - Phone:408-625-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHF00071304247100000X
CARHF00098645247100000X
CARHF00089936247100000X
CARHF00070286247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist