Provider Demographics
NPI:1912342064
Name:LINGENFELTER, LAWRENCE CLARENCE III
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:CLARENCE
Last Name:LINGENFELTER
Suffix:III
Gender:M
Credentials:
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 99
Mailing Address - Street 2:
Mailing Address - City:MARIPOSA
Mailing Address - State:CA
Mailing Address - Zip Code:95338-0099
Mailing Address - Country:US
Mailing Address - Phone:209-742-1292
Mailing Address - Fax:209-742-5961
Practice Address - Street 1:5091 BULLION ST
Practice Address - Street 2:
Practice Address - City:MARIPOSA
Practice Address - State:CA
Practice Address - Zip Code:95338-2416
Practice Address - Country:US
Practice Address - Phone:209-742-1292
Practice Address - Fax:209-742-5961
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAI3443146N00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic