Provider Demographics
NPI:1790335032
Name:LENTHE, MYCALAH ANNE
Entity Type:Individual
Prefix:
First Name:MYCALAH
Middle Name:ANNE
Last Name:LENTHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 JASMINE PL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-7013
Mailing Address - Country:US
Mailing Address - Phone:925-878-8179
Mailing Address - Fax:
Practice Address - Street 1:1557 JASMINE PL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-7013
Practice Address - Country:US
Practice Address - Phone:925-878-8179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider