Provider Demographics
NPI:1720872195
Name:LEWIS, LEEMARIE MONZON (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LEEMARIE
Middle Name:MONZON
Last Name:LEWIS
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:LEEMARIE
Other - Middle Name:RAGADIO
Other - Last Name:MONZON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:511 S KROEGER ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-4728
Mailing Address - Country:US
Mailing Address - Phone:951-719-9440
Mailing Address - Fax:
Practice Address - Street 1:511 S KROEGER ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-4728
Practice Address - Country:US
Practice Address - Phone:951-719-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95033239363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health