Provider Demographics
NPI:1821197377
Name:OWENS-LEWIS, KIRONDA M (MD)
Entity Type:Individual
Prefix:
First Name:KIRONDA
Middle Name:M
Last Name:OWENS-LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIRONDA
Other - Middle Name:
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:72780 COUNTRY CLUB DR STE 305
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4149
Mailing Address - Country:US
Mailing Address - Phone:760-837-8747
Mailing Address - Fax:760-837-8749
Practice Address - Street 1:72780 COUNTRY CLUB DR STE 305
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4149
Practice Address - Country:US
Practice Address - Phone:760-837-8747
Practice Address - Fax:760-837-8749
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC169115207Q00000X
GA051704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
08BBRVSMedicare ID - Type Unspecified
H76500Medicare UPIN