Provider Demographics
NPI:1588643795
Name:LEN, TRICIA A (MD)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:A
Last Name:LEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:ANN
Other - Last Name:LEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:TRICIA A LEN MD
Mailing Address - Street 1:2104 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5704
Mailing Address - Country:US
Mailing Address - Phone:310-828-8258
Mailing Address - Fax:310-828-5258
Practice Address - Street 1:2104 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5704
Practice Address - Country:US
Practice Address - Phone:310-828-8258
Practice Address - Fax:310-828-5258
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD071469L207R00000X
CAA74181207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH28911Medicare UPIN