Provider Demographics
NPI:1912923004
Name:LEWIS, NATHAN L (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 S ARROYO PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3264
Mailing Address - Country:US
Mailing Address - Phone:626-796-8181
Mailing Address - Fax:626-796-1874
Practice Address - Street 1:675 S ARROYO PKWY STE 310
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-796-8181
Practice Address - Fax:626-796-1874
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG40994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48424Medicare UPIN
CAWG40994LMedicare PIN