Healthcare Provider Details

I. General information

NPI: 1396301529
Provider Name (Legal Business Name): ALEX CRANE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12395 EL CAMINO REAL
SAN DIEGO CA
92130-3082
US

IV. Provider business mailing address

10790 RANCHO BERNARDO RD
SAN DIEGO CA
92127-5705
US

V. Phone/Fax

Practice location:
  • Phone: 858-793-2727
  • Fax: 858-793-2650
Mailing address:
  • Phone: 858-793-2727
  • Fax: 858-793-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA180454
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA180454
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: