Provider Demographics
NPI:1790087096
Name:NL LEWIS MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NL LEWIS MD A PROFESSIONAL CORPORATION
Other - Org Name:PACIFIC MEDICAL GROUP, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-796-8181
Mailing Address - Street 1:675 S ARROYO PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3264
Mailing Address - Country:US
Mailing Address - Phone:626-796-8181
Mailing Address - Fax:626-796-1874
Practice Address - Street 1:675 S ARROYO PKWY STE 310
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-796-8181
Practice Address - Fax:626-796-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-19
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty