Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E2338 | CA |
Y | 222Z00000X | Podiatrist | E2338 | CA |
NPI | 1003868100 |
---|---|
Provider Name | Craig Anthony Lenz |
First Address | San Dimas, CA 91773-2543 |
Second Address | Stockton, CA 95209-2900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 14/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000E23380 | (05) | CA |
480008511 | MEDICARE RAIL ROAD (01) | CA |
T11293 | (02) | CA |