Basic Information
| Provider Information | |||||||||
| NPI: | 1124096177 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STENZLER | ||||||||
| FirstName: | LEE | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1801 E MARCH LN | ||||||||
| Address2: | STE D400 | ||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094643615 | ||||||||
| FaxNumber: | 2094641311 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 E MARCH LN | ||||||||
| Address2: | STE D400 | ||||||||
| City: | STOCKTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2094643615 | ||||||||
| FaxNumber: | 2094641311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 08/22/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | G535850 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00G535850 | 05 | CA | MEDICAID | G53585 | 01 | CA | MEDICAL LICENSE NUMBER | OTHER | AS2929303 | 01 | CA | DEA NUMBER | OTHER |