=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477583060
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAWRENCE JOSEPH LENZ M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 12/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 205 VIEW CT.
-----------------------------------------------------
City | APTOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-688-5069
-----------------------------------------------------
Fax | 831-688-5069
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 205 VIEW CT.
-----------------------------------------------------
City | APTOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-688-5069
-----------------------------------------------------
Fax | 831-688-5069
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A26130
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------