Provider Demographics
NPI:1265498570
Name:LENZ, ANITA I (MD)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:I
Last Name:LENZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ANITA
Other - Middle Name:I
Other - Last Name:LENZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9041 MAGNOLIA AVE
Mailing Address - Street 2:206
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3900
Mailing Address - Country:US
Mailing Address - Phone:951-354-0676
Mailing Address - Fax:
Practice Address - Street 1:9041 MAGNOLIA AVE
Practice Address - Street 2:206
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3900
Practice Address - Country:US
Practice Address - Phone:951-354-0676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38207174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47398Medicare UPIN