Provider Demographics
NPI:1003868100
Name:LENZ, CRAIG ANTHONY (DPM)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:ANTHONY
Last Name:LENZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 W BONITA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2543
Mailing Address - Country:US
Mailing Address - Phone:909-599-0981
Mailing Address - Fax:909-592-0738
Practice Address - Street 1:1755 W HAMMER LN STE 7B
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2900
Practice Address - Country:US
Practice Address - Phone:909-599-0891
Practice Address - Fax:909-592-0738
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2338213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E23380Medicaid
CA480008511OtherMEDICARE RAIL ROAD
CA000E23380Medicaid
CA000E23382Medicare PIN