Provider Demographics
NPI:1942447248
Name:MARSHALL S. LEWIS A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:MARSHALL S. LEWIS A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:VILCHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-430-9180
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:661-327-1425
Mailing Address - Fax:661-325-0837
Practice Address - Street 1:2619 F ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1815
Practice Address - Country:US
Practice Address - Phone:661-327-1425
Practice Address - Fax:661-325-0837
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARSHALL S. LEWIS A PROFESSIONAL CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28242174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty