Provider Demographics
NPI:1144333436
Name:ALTENAU, LANCE L (MD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:L
Last Name:ALTENAU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8010 FROST ST
Mailing Address - Street 2:STE 414
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4235
Mailing Address - Country:US
Mailing Address - Phone:619-297-4481
Mailing Address - Fax:
Practice Address - Street 1:2100 5TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2102
Practice Address - Country:US
Practice Address - Phone:619-297-4481
Practice Address - Fax:619-291-5536
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC38631207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC38631BMedicare PIN
CAWC38631GMedicare PIN
CAA36970Medicare UPIN