1124096177 NPI number — DR. LEE MICHAEL STENZLER MD

Table of content: DR. LEE MICHAEL STENZLER MD (NPI 1124096177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124096177 NPI number — DR. LEE MICHAEL STENZLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STENZLER
Provider First Name:
LEE
Provider Middle Name:
MICHAEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124096177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 E MARCH LN
Provider Second Line Business Mailing Address:
STE D400
Provider Business Mailing Address City Name:
STOCKTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-464-3615
Provider Business Mailing Address Fax Number:
209-464-1311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 E MARCH LN
Provider Second Line Business Practice Location Address:
STE D400
Provider Business Practice Location Address City Name:
STOCKTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-464-3615
Provider Business Practice Location Address Fax Number:
209-464-1311
Provider Enumeration Date:
03/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  G535850 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G535850 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G53585 . This is a "MEDICAL LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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