Provider Demographics
NPI:1609200203
Name:MARSHALL S. LEWIS, MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARSHALL S. LEWIS, MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALVAN
Authorized Official - Suffix:
Authorized Official - Credentials:RMA
Authorized Official - Phone:661-861-0011
Mailing Address - Street 1:2619 F ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1815
Mailing Address - Country:US
Mailing Address - Phone:661-861-0011
Mailing Address - Fax:661-861-1011
Practice Address - Street 1:1031 N DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4117
Practice Address - Country:US
Practice Address - Phone:559-635-7400
Practice Address - Fax:559-635-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-30
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC18251111N00000X
CAAC9103171100000X
CAG282420174400000X
CAPA15629363A00000X
CA786817363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty