Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A72730 | CA |
Y | 2084N0402X | Child Neurologist | A72730 | CA |
NPI | 1285773366 |
---|---|
Provider Name | Ann J Lewis |
First Address | Santa Clara, CA 95051-5173 |
Second Address | Santa Clara, CA 95051-5173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A727300 | (05) | CA |
I12711 | (02) | CA |