Provider Demographics
NPI:1336399567
Name:LANCE L. ALTENAU
Entity Type:Organization
Organization Name:LANCE L. ALTENAU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:ALTENAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-481-6624
Mailing Address - Street 1:3525 DEL MAR HEIGHTS RD # 355
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2122
Mailing Address - Country:US
Mailing Address - Phone:858-481-6625
Mailing Address - Fax:
Practice Address - Street 1:3525 DEL MAR HEIGHTS RD # 355
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2122
Practice Address - Country:US
Practice Address - Phone:858-481-6625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC38631207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty