Provider Demographics
NPI:1902045123
Name:LEWIS, LUCENDA BONNER
Entity Type:Individual
Prefix:MS
First Name:LUCENDA
Middle Name:BONNER
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 N LAKE AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-2300
Mailing Address - Country:US
Mailing Address - Phone:626-398-3796
Mailing Address - Fax:626-398-3895
Practice Address - Street 1:1460 N LAKE AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2300
Practice Address - Country:US
Practice Address - Phone:626-398-3796
Practice Address - Fax:626-398-3895
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program