Provider Demographics
NPI:1790546315
Name:SPENCER, LANCE (ADMIN/SUPPORT SPECIA)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:ADMIN/SUPPORT SPECIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-0950
Mailing Address - Country:US
Mailing Address - Phone:530-528-2938
Mailing Address - Fax:530-528-8034
Practice Address - Street 1:2608 VICTOR AVE STE A
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1447
Practice Address - Country:US
Practice Address - Phone:530-722-1022
Practice Address - Fax:530-722-1058
Is Sole Proprietor?:No
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist