Healthcare Provider Details

I. General information

NPI: 1215439807
Provider Name (Legal Business Name): CHRISTOPHER ALLEN LANE JR. RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 HURLEY WAY STE 290
SACRAMENTO CA
95825-3221
US

IV. Provider business mailing address

2035 HURLEY WAY STE 290
SACRAMENTO CA
95825-3221
US

V. Phone/Fax

Practice location:
  • Phone: 916-758-9768
  • Fax: 916-550-1124
Mailing address:
  • Phone: 916-758-9768
  • Fax: 916-550-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License NumberRBT-18-61333
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: