MEDICARE: DR. WILLIAM R LENABURG M.D.

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	207Q00000X	Family Medicine Physician	G51103	CA

General Provider Information

NPI Number	:	1871562496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM R LENABURG M.D.

Provider Business Mailing Address
First Line	:	16661 VENTURA BLVD
Second Line	:	SUITE 108
City	:	ENCINO
State	:	CA
Zip	:	91436-1914
Country	:	US
Telephone Number	:	818-808-2828
Fax Number	:	818-788-0386

Provider Business Practice Location Address
First Line	:	16661 VENTURA BLVD
Second Line	:	SUITE 108
City	:	ENCINO
State	:	CA
Zip	:	91436-1914
Country	:	US
Telephone Number	:	818-808-2828
Fax Number	:	818-788-0386

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	12/29/2015

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