Provider Demographics
NPI:1043424617
Name:LENERS, PAUL JAMES (SURFACE IDC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:JAMES
Last Name:LENERS
Suffix:
Gender:M
Credentials:SURFACE IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 122213
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92112-2213
Mailing Address - Country:US
Mailing Address - Phone:858-692-3799
Mailing Address - Fax:
Practice Address - Street 1:3455 STURTEVANT ST STE 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92136-5069
Practice Address - Country:US
Practice Address - Phone:619-556-0935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman