1144292228 NPI number — DR. LEWIS CHARLES CARR PH.D., ABPP

Table of content: CINDYL LEE MAUZEY NP-C (NPI 1790154482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144292228 NPI number — DR. LEWIS CHARLES CARR PH.D., ABPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARR
Provider First Name:
LEWIS
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D., ABPP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CARR
Provider Other First Name:
L.
Provider Other Middle Name:
CHARLES
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D., ABPP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144292228
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4929 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE NUMBER 510
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90010-3808
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-904-3999
Provider Business Mailing Address Fax Number:
855-688-6746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4929 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE NUMBER 510
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90010-3808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-904-3999
Provider Business Practice Location Address Fax Number:
855-688-6746
Provider Enumeration Date:
02/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  2150 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PSY26808 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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