Provider Demographics
NPI:1750847356
Name:LEWIS, YAYOI (FCFP)
Entity Type:Individual
Prefix:
First Name:YAYOI
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FCFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 NORTHGATE DR # 187
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2500
Mailing Address - Country:US
Mailing Address - Phone:415-272-5529
Mailing Address - Fax:
Practice Address - Street 1:1717 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1810
Practice Address - Country:US
Practice Address - Phone:415-272-5529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist