Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A164119 | CA |
NPI | 1023514130 |
---|---|
Provider Name | Dr. Zachary Malcolm Lenane |
First Address | San Mateo, CA 94403-4324 |
Second Address | San Mateo, CA 94403-4324 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2018 |
Last Update Date | 07/08/2019 |