Organization
CHARLES LEWIS MD PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE E SHELL (BILLING AGENT)
(760) 539-7700
Entity
Organization
Contact information
Practice address
8318 UNIVERSITY AVE, SUITE A5, LA MESA, CA 91942-3865
(619) 579-2187
(619) 579-2187
Mailing address
8318 UNIVERSITY AVE, SUITE A5, LA MESA, CA 91942-9358
(619) 579-2187
(619) 579-2187
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
LCS9115
CA
2084P0800X
Psychiatry Physician
Primary
C33286
CA
Other
Enumeration date
01/25/2008
Last updated
11/03/2014
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