Healthcare Provider Details

I. General information

NPI: 1174132310
Provider Name (Legal Business Name): SHANNAH LENTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 OAK RD STE 100
WALNUT CREEK CA
94597-2078
US

IV. Provider business mailing address

5101 E TWAIN AVE APT 27
LAS VEGAS NV
89122-4680
US

V. Phone/Fax

Practice location:
  • Phone: 510-422-3959
  • Fax:
Mailing address:
  • Phone: 707-430-3997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT1256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: