Provider Demographics
NPI:1922101534
Name:LENZKES, BRIAN JOSEPH (MD)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:LENZKES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9505 HINTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071
Mailing Address - Country:US
Mailing Address - Phone:619-562-2788
Mailing Address - Fax:
Practice Address - Street 1:3260 THIRD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-297-3737
Practice Address - Fax:619-297-0443
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A745240OtherBLUESHIELD
CAA74524OtherHMO
CA00A745240Medicaid
CA952585978OtherCHAMPUS
CAA74524OtherBLUECROSS
CAA74524OtherPPO/COMM
CAWA74524AMedicare ID - Type Unspecified
CAA74524OtherBLUECROSS