Provider Demographics
NPI:1194416412
Name:LEWIS, CORINNE MARIE
Entity type:Individual
Prefix:
First Name:CORINNE
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CORINNE
Other - Middle Name:MARIE
Other - Last Name:LOCKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:655 E HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3636
Mailing Address - Country:US
Mailing Address - Phone:626-471-9922
Mailing Address - Fax:
Practice Address - Street 1:655 E HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3636
Practice Address - Country:US
Practice Address - Phone:626-471-9922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC001715170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS