Healthcare Provider Details

I. General information

NPI: 1568999738
Provider Name (Legal Business Name): AKILA CRANE MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2017
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4253 KANSAS AVE
RIVERSIDE CA
92507-5151
US

IV. Provider business mailing address

PO BOX 52258
RIVERSIDE CA
92517-3258
US

V. Phone/Fax

Practice location:
  • Phone: 951-907-6820
  • Fax: 951-907-6820
Mailing address:
  • Phone: 951-907-6820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberB7667621
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: