Provider Demographics
NPI:1265618763
Name:LEWIS, LORI RUTH (BA TEACHER)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:RUTH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BA TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-2235
Mailing Address - Country:US
Mailing Address - Phone:619-307-1027
Mailing Address - Fax:
Practice Address - Street 1:1400 N JOHNSON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1650
Practice Address - Country:US
Practice Address - Phone:619-442-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker