Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | RBT-18-61333 | OR |
NPI | 1215439807 |
---|---|
Provider Name | Christopher Allen Lane JR. |
First Address | Sacramento, CA 95825-3221 |
Second Address | Sacramento, CA 95825-3221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2018 |
Last Update Date | 01/10/2021 |