Healthcare Provider Details

I. General information

NPI: 1720738685
Provider Name (Legal Business Name): ANNIKA M. LENZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 STOCKTON BLVD
SACRAMENTO CA
95817-2215
US

IV. Provider business mailing address

2425 STOCKTON BLVD
SACRAMENTO CA
95817-2215
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-2191
  • Fax:
Mailing address:
  • Phone: 916-453-2191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number13504648-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License Number211589
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number13504648-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: