Provider Demographics
NPI:1932604261
Name:LEWIS, MANUEL DIAZ (DO)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:DIAZ
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1369 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-1594
Mailing Address - Country:US
Mailing Address - Phone:605-391-0030
Mailing Address - Fax:
Practice Address - Street 1:2700 DOLBEER ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501-4799
Practice Address - Country:US
Practice Address - Phone:707-269-4253
Practice Address - Fax:707-269-4253
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A18972207R00000X, 208M00000X
ORDO203809208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine