Provider Demographics
NPI:1437987328
Name:LEWIS, DERRICK D
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 DUFRESNE CT APT 19
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-6939
Mailing Address - Country:US
Mailing Address - Phone:323-875-5446
Mailing Address - Fax:
Practice Address - Street 1:3760 DUFRESNE CT APT 19
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-6939
Practice Address - Country:US
Practice Address - Phone:323-875-5446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care