Healthcare Provider Details

I. General information

NPI: 1285832121
Provider Name (Legal Business Name): ALECIA LENTZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 11/05/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 BECK AVE # MS 5-215
FAIRFIELD CA
94533-6804
US

IV. Provider business mailing address

1310 CLUB DRIVE ADMIN & FACULTY 1-ROOM 224
VALLEJO CA
94592
US

V. Phone/Fax

Practice location:
  • Phone: 707-784-2010
  • Fax:
Mailing address:
  • Phone: 724-396-3745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO3548
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code2471C1101X
TaxonomyCardiovascular-Interventional Technology Radiologic Technologist
License Number641841
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2471C1101X
TaxonomyCardiovascular-Interventional Technology Radiologic Technologist
License Number13448
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A22972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: