Provider Demographics
NPI:1639266133
Name:LENDARIS, GEORGE NICK (RPT)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:NICK
Last Name:LENDARIS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 BEARD RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3490
Mailing Address - Country:US
Mailing Address - Phone:707-257-0686
Mailing Address - Fax:707-257-7670
Practice Address - Street 1:3030 BEARD RD
Practice Address - Street 2:SUITE B
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3490
Practice Address - Country:US
Practice Address - Phone:707-257-0686
Practice Address - Fax:707-257-7670
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9097174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist