Provider Demographics
NPI:1538170204
Name:CRAIG ANTHONY LENZ
Entity type:Organization
Organization Name:CRAIG ANTHONY LENZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:909-599-0981
Mailing Address - Street 1:8543 BURNS PL
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-2633
Mailing Address - Country:US
Mailing Address - Phone:209-474-8020
Mailing Address - Fax:559-325-7952
Practice Address - Street 1:1755 W HAMMER LN STE 7B
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209
Practice Address - Country:US
Practice Address - Phone:209-474-8020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2338213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGRE000360Medicaid
CAZZZ20984ZMedicare ID - Type Unspecified
CAZZZ30457ZMedicare ID - Type Unspecified
CAZZZ21789ZMedicare ID - Type Unspecified
CAGRE000360Medicaid
CAZZZ21787ZMedicare ID - Type Unspecified
CAZZZ20989ZMedicare ID - Type Unspecified