Individual
BEVERLY LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
900 S MAIN ST STE 105, CORONA, CA 92882-3401
(951) 363-0243
Mailing address
29306 CATALPA, LAKE ELSINORE, CA 92530-9100
(310) 806-1002
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G42697
CA
208D00000X
General Practice Physician
G42697
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0040370
—
CA
Enumeration date
02/16/2006
Last updated
02/01/2021
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