Provider Demographics
NPI:1043302052
Name:LEWIS, ROYA (MD)
Entity type:Individual
Prefix:
First Name:ROYA
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2701 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 503
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4402
Mailing Address - Country:US
Mailing Address - Phone:818-845-0088
Mailing Address - Fax:818-845-0924
Practice Address - Street 1:2701 W ALAMEDA AVE
Practice Address - Street 2:SUITE 503
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4402
Practice Address - Country:US
Practice Address - Phone:818-845-0088
Practice Address - Fax:818-845-0924
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4255132084P0800X
CAA908172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD425513OtherLICENSE
CAA90817OtherLICENSE