Healthcare Provider Details

I. General information

NPI: 1285597328
Provider Name (Legal Business Name): CHRISTINA CRANE PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 BUCKMAN SPRINGS RD
PINE VALLEY CA
91962-4005
US

IV. Provider business mailing address

3305 BUCKMAN SPRINGS RD
PINE VALLEY CA
91962-4005
US

V. Phone/Fax

Practice location:
  • Phone: 619-473-9022
  • Fax:
Mailing address:
  • Phone: 619-473-9022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number250127679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: