Provider Demographics
NPI:1285832121
Name:LENTZ, ALECIA (DO)
Entity type:Individual
Prefix:
First Name:ALECIA
Middle Name:
Last Name:LENTZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 CLUB DRIVE
Mailing Address - Street 2:ADMIN & FACULTY 1-ROOM 224
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94592
Mailing Address - Country:US
Mailing Address - Phone:724-396-3745
Mailing Address - Fax:
Practice Address - Street 1:275 BECK AVE # MS 5-215
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6804
Practice Address - Country:US
Practice Address - Phone:707-784-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3548207Q00000X
NJ6418412471C1101X
AZ134482471C1101X
390200000X
CA20A22972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2471C1101XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistCardiovascular-Interventional Technology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program