Healthcare Provider Details

I. General information

NPI: 1043408479
Provider Name (Legal Business Name): CHRISTOPHER T. LANE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2007
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N TUSTIN AVE 109
SANTA ANA CA
92705-3528
US

IV. Provider business mailing address

999 N TUSTIN AVE 109
SANTA ANA CA
92705-3528
US

V. Phone/Fax

Practice location:
  • Phone: 714-954-1182
  • Fax: 714-953-3425
Mailing address:
  • Phone: 714-954-1182
  • Fax: 714-953-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA61513
License Number StateCA

VIII. Authorized Official

Name: DR. CHRISTOPHER TROY LANE
Title or Position: PRESIDENT
Credential: MD
Phone: 714-954-1182