Basic Information
| Provider Information | |||||||||
| NPI: | 1497857999 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LESSNER | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1079 EUCALYPTUS ST, SUITE#A | ||||||||
| Address2: | |||||||||
| City: | MANTECA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2092396008 | ||||||||
| FaxNumber: | 2092393408 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 W RIVERSIDE DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | PARKER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853445119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9282564110 | ||||||||
| FaxNumber: | 9287226113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2006 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | G33868 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208000000X | 33868 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 594551 | 05 | AZ | MEDICAID |