Healthcare Provider Details

I. General information

NPI: 1306762877
Provider Name (Legal Business Name): TRAVIS PANGILINAN LANE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 GROSSMONT COLLEGE DR
EL CAJON CA
92020-1799
US

IV. Provider business mailing address

455 BLUE SAGE WAY
OCEANSIDE CA
92057-7652
US

V. Phone/Fax

Practice location:
  • Phone: 619-644-7000
  • Fax:
Mailing address:
  • Phone: 760-637-0568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: