Provider Demographics
NPI:1477583060
Name:LENZ, LAWRENCE JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:JOSEPH
Last Name:LENZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 VIEW CT.
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003
Mailing Address - Country:US
Mailing Address - Phone:831-688-5069
Mailing Address - Fax:831-688-5069
Practice Address - Street 1:205 VIEW CT.
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003
Practice Address - Country:US
Practice Address - Phone:831-688-5069
Practice Address - Fax:831-688-5069
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA26130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26130OtherMEDICAL LICENSE
CA00A261300Medicaid
CAA24742Medicare UPIN