Provider Demographics
NPI:1881426476
Name:LEWIS-UPTON, MARGARITA LUCAS
Entity type:Individual
Prefix:MRS
First Name:MARGARITA
Middle Name:LUCAS
Last Name:LEWIS-UPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARGARITA
Other - Middle Name:LUCAS
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5853 VENTANA DR
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-5615
Mailing Address - Country:US
Mailing Address - Phone:909-641-0717
Mailing Address - Fax:
Practice Address - Street 1:16854 IVY AVE STE A
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-1504
Practice Address - Country:US
Practice Address - Phone:909-791-1000
Practice Address - Fax:909-781-6000
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033971363LG0600X
CA774371163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse