MEDICARE: CANDICE LENTZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1407448434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE LENTZ

Provider Business Mailing Address
First Line	:	8700 AUBURN FOLSOM RD STE 300
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-8501
Country	:	US
Telephone Number	:	916-461-3390
Fax Number	:

Provider Business Practice Location Address
First Line	:	8700 AUBURN FOLSOM RD STE 300
Second Line	:
City	:	GRANITE BAY
State	:	CA
Zip	:	95746-8501
Country	:	US
Telephone Number	:	916-461-3390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2021
Last Update Date	:	02/10/2021

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Directions to “ CANDICE LENTZ ” Practice Location

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