Provider Demographics
NPI:1780759431
Name:DELA PAZ, LENNIE RAMIREZ (MD)
Entity type:Individual
Prefix:
First Name:LENNIE
Middle Name:RAMIREZ
Last Name:DELA PAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 SOUTH EUCLID AVENUE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2953
Mailing Address - Country:US
Mailing Address - Phone:619-475-3600
Mailing Address - Fax:619-475-4746
Practice Address - Street 1:610 SOUTH EUCLID AVENUE
Practice Address - Street 2:SUITE 303
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2953
Practice Address - Country:US
Practice Address - Phone:619-475-3600
Practice Address - Fax:619-475-4746
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31351207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A313510Medicaid
A31351Medicare ID - Type Unspecified
CA00A313510Medicaid