Provider Demographics
NPI:1528083052
Name:LEWIS, PATRICIA LEE (LAC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3990 OLD TOWN AVE
Mailing Address - Street 2:SUITE B-107
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2930
Mailing Address - Country:US
Mailing Address - Phone:619-291-1296
Mailing Address - Fax:619-291-1201
Practice Address - Street 1:3990 OLD TOWN AVE
Practice Address - Street 2:SUITE B-107
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2930
Practice Address - Country:US
Practice Address - Phone:619-291-1296
Practice Address - Fax:619-291-1201
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6917171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist