Provider Demographics
NPI:1457543894
Name:LEWIS, MEARLE DAVID
Entity Type:Individual
Prefix:DR
First Name:MEARLE
Middle Name:DAVID
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6150
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90264
Mailing Address - Country:US
Mailing Address - Phone:310-589-1600
Mailing Address - Fax:310-589-1607
Practice Address - Street 1:115 BARRINGTON WALK
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-2931
Practice Address - Country:US
Practice Address - Phone:310-589-1600
Practice Address - Fax:310-589-1607
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39057323P00000X, 324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOC39057OtherMEDICAL
CAGR 005999OtherMEDICAL UPIN
W1173Medicare PIN
CAGR 005999OtherMEDICAL UPIN