Provider Demographics
NPI:1841049665
Name:LEWIS, DOROTHY MARIE
Entity type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:MARIE
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 1:7056 ARCHIBALD AVE STE 102-314
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-8713
Mailing Address - Country:US
Mailing Address - Phone:951-900-4786
Mailing Address - Fax:
Practice Address - Street 1:7056 ARCHIBALD AVE STE 102-314
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-8713
Practice Address - Country:US
Practice Address - Phone:951-900-4786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker