Provider Demographics
NPI:1912998196
Name:LENER, ELIZABETH V (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:V
Last Name:LENER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 CORPORATE DRIVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-2111
Mailing Address - Country:US
Mailing Address - Phone:949-364-8411
Mailing Address - Fax:949-364-8511
Practice Address - Street 1:600 CORPORATE DRIVE
Practice Address - Street 2:SUITE 240
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-2111
Practice Address - Country:US
Practice Address - Phone:949-364-8411
Practice Address - Fax:949-364-8511
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75400207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00754000OtherBLUE SHIELD GROUP NO
CALEZAOtherWEBMD SITE ID
CA201666218OtherPROVIDER TAX ID - S CORP
CAA75400OtherSTATE MEDICAL LICENSE NO
CAA75400OtherSTATE MEDICAL LICENSE NO
CA00754000OtherBLUE SHIELD GROUP NO
CAH43178Medicare UPIN