Healthcare Provider Details

I. General information

NPI: 1750367298
Provider Name (Legal Business Name): JAMES RICHARD LANE ITALIANE BC-HIS, ACA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24022 CALLE DE LA PLATA SUITE 415
LAGUNA HILLS CA
92653-3626
US

IV. Provider business mailing address

24022 CALLE DE LA PLATA SUITE 415
LAGUNA HILLS CA
92653-3626
US

V. Phone/Fax

Practice location:
  • Phone: 949-859-7553
  • Fax: 949-859-9256
Mailing address:
  • Phone: 949-859-7553
  • Fax: 949-859-9256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA756
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: