Healthcare Provider Details

I. General information

NPI: 1033272901
Provider Name (Legal Business Name): LISA RENEE CRANE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 06/28/2021
Certification Date: 06/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 BARRANCA PKWY STE 200
IRVINE CA
92604-1723
US

IV. Provider business mailing address

4050 BARRANCA PKWY STE 200
IRVINE CA
92604-1723
US

V. Phone/Fax

Practice location:
  • Phone: 949-559-1911
  • Fax: 949-559-4071
Mailing address:
  • Phone: 949-559-1911
  • Fax: 949-559-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA54373
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA54373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: