JERRY LANE LEWIS (NPI# 1801879341) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801879341 |
| Entity Type | Individual |
| Full Name | JERRY LANE LEWIS |
| Credential | PA |
| Practice Address |
9235 E Broadway St Planada CA 95365-8088 |
| Mailing Address |
737 W Childs Ave Merced CA 95340-6805 |
| Practice Telephone | 2093820253 |
| Practice Fax Number | 2093822110 |
| Mailing Telephone | 2093831848 |
| Mailing Fax Number | 2093831296 |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2012-01-05 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA11479 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | DEA CERT | ML0489826 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194376178 | Jerry Lewis | Counselor | 1606r W Cherry St, Clarksville, AR 72830-2506 | 2019-09-22 |
| 1710050547 | Jerry Lewis | Technician, Other | 3041 W Avenue K, Lancaster, CA 93536-5402 | 2006-11-17 |
| 1235745340 | Jerry A Lewis | Technician | 23 Senior Center Dr, Sutton, WV 26601-9581 | 2020-09-23 |
| 1568744662 | Jerry Bret Lewis | Pharmacist | 4315 Centennial Blvd, Colorado Springs, CO 80907-3769 | 2011-09-14 |
| 1134234297 | Jerry Mermod Lewis IIi | Psychiatry & Neurology | 8226 Douglas Ave, Suite #805, Dallas, TX 75225-5943 | 2006-08-20 |
| 1124005152 | Jerry Wayne Lewis | Anesthesiology | 5757 Warren Pkwy, Suite 110, Frisco, TX 75034-4274 | 2005-12-30 |
| Street Address |
9235 E BROADWAY ST |
| City | PLANADA |
| State | CA |
| Zip Code | 95365-8088 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003380452 | Stephanie D Hernandez | Registered Nurse | 9235 E Broadway St, Planada, CA 95365-8088 | 2019-01-18 |
| 1396145611 | Eva Lomeli | Social Worker | 9235 E Broadway St, Planada, CA 95365-8088 | 2014-08-25 |
| 1679982979 | Shirley Ann Perido Pasia | Nurse Practitioner | 9235 E Broadway St, Planada, CA 95365-8088 | 2014-08-12 |
| 1952660326 | Maxine Mary Fotadar | Dentist | 9235 E Broadway St, Planada, CA 95365-8088 | 2012-05-04 |
| 1669587382 | John Edward Wanzo | Dentist | 9235 E Broadway St, Planada, CA 95365-8088 | 2006-08-21 |
| 1235114745 | Golden Valley Health Center | Clinic/Center | 9235 E Broadway St, Planada, CA 95365-8088 | 2005-12-08 |
| 1124002688 | Jelin Yen Truong | Family Medicine | 9235 E Broadway St, Planada, CA 95365-8088 | 2005-11-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992925796 | Golden Valley Health Centers | Social Worker | 9235 E Broadway, Planada, CA 95365 | 2007-04-26 |
| 1407839970 | John Robert Lee | Dentist | 9235 E. Broadway, Planada, CA 95365 | 2005-11-29 |
| 1801016605 | Golden Valley Health Centers | Family Medicine | 9235 E Broadway, Planada, CA 95365 | 2007-04-26 |
| 1710107511 | Golden Valley Health Centers | Family Medicine | 9235 E Broadway, Planada, CA 95365 | 2007-04-26 |
| 1750365037 | Ronald A. Marquez | Dentist | 9235 E. Broadway, Planada, CA 95365 | 2005-12-01 |
| 1891981569 | Planada Elementary School District | Local Education Agency (LEA) | 161 So. Plainsburg Road, Planada, CA 95365-0236 | 2007-09-17 |
| 1982788170 | San Joaquin Drug Incorporated | Durable Medical Equipment & Medical Supplies | 9215 East Highway 140, Planada, CA 95365-1636 | 2006-10-24 |
| 1871047555 | Katherine Elizabeth Bass | Pharmacist | 9215 E Highway 140, Planada, CA 95365-8245 | 2016-08-10 |
| 1609339639 | Thomas M Bass | Pharmacist | 9215 E Highway 140, Planada, CA 95365-8245 | 2019-04-08 |
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760089437 | Karine Harutyunyan | Physician Assistant | 500 E Colorado St Ste 101, Glendale, CA 91205-1607 | 2020-10-06 |
| 1437756228 | Kale Burket | Physician Assistant | Bldg 523, S 8th St, El Centro, CA 92243 | 2020-10-05 |
| 1548867666 | Heba Marzouk Al-shoubaki | Physician Assistant | 633 S Pepper St, Anaheim, CA 92802-1459 | 2020-10-01 |
| 1275140550 | Lisa Lynn Passalacqua | Physician Assistant | 431 7th St, Norco, CA 92860-1671 | 2020-09-30 |
| 1144833989 | Trisha Taylor | Physician Assistant | 10399 Tivoli Way, Yucaipa, CA 92399-6017 | 2020-08-30 |
| 1457963944 | Harlan William Monahan | Physician Assistant | 5210 Del Rio Rd, Sacramento, CA 95822-2519 | 2020-08-18 |
| 1275144313 | Sofia Carmen Bustillo | Physician Assistant | 1709 Coral Pl, Seal Beach, CA 90740-5712 | 2020-08-12 |
| 1124638663 | Gayaneh Gharakhani | Physician Assistant | 1323 E Broadway Apt 110, Glendale, CA 91205-4018 | 2020-08-07 |
| 1144830183 | Loc Bao Tran | Physician Assistant | 8937 Emerson Pl, Rosemead, CA 91770-2813 | 2020-08-04 |
| 1558997957 | Sarah Lubinsky | Physician Assistant | 1511 Montana Ave, Santa Monica, CA 90403-1891 | 2020-03-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.