Provider Demographics
NPI:1730641333
Name:LENT, MICAH CRYSTAL (CPT)
Entity Type:Individual
Prefix:
First Name:MICAH
Middle Name:CRYSTAL
Last Name:LENT
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:MICAH
Other - Middle Name:CRYSTAL
Other - Last Name:RUBIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPT
Mailing Address - Street 1:250 N SEE VEE LN
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-8130
Mailing Address - Country:US
Mailing Address - Phone:760-873-8461
Mailing Address - Fax:760-873-3935
Practice Address - Street 1:250 N SEE VEE LN
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-8130
Practice Address - Country:US
Practice Address - Phone:760-873-8461
Practice Address - Fax:760-873-3935
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT00019080246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CATHP11576FMedicaid