Provider Demographics
NPI:1134552953
Name:LEWIS, MARINA SAUCEDA (RN, MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:SAUCEDA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:RN, MSN, PMHNP-BC
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:LAUREN
Other - Last Name:SAUCEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, MSN, PMHNP-BC
Mailing Address - Street 1:1436 GOODRICH BLVD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5111
Mailing Address - Country:US
Mailing Address - Phone:323-725-1337
Mailing Address - Fax:
Practice Address - Street 1:1436 GOODRICH BLVD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90022-5111
Practice Address - Country:US
Practice Address - Phone:323-725-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA837157163W00000X
CA95002737363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse