Individual
ALICIA LEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17 DAVIS BLVD STE 308, TAMPA, FL 33606-3438
(813) 259-8725
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
(813) 974-2201
(813) 974-4325
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME148895
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110924600
—
FL
01
—
JUAFM
BLUE CROSS BLUE SHIELD
FL
Enumeration date
04/23/2018
Last updated
07/21/2021
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