Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | G60815 | CA |
NPI | 1295883155 |
---|---|
Provider Name | Richard E. Lewis |
First Address | Riverside, CA 92505-3043 |
Second Address | Riverside, CA 92505-3043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 29/11/2021 |