Individual
ELLIETON BOBBY LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1825 NW 167TH ST, MIAMI GARDENS, FL 33056-4838
(786) 263-3392
(305) 623-7893
Mailing address
1825 NW 167TH ST, MIAMI GARDENS, FL 33056-4838
(786) 263-3392
(305) 623-7893
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891859575
—
FL
Enumeration date
09/11/2019
Last updated
09/11/2019
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