MEDICARE: PHYLLIS HENRIETTA CRANE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY14486	CA

General Provider Information

NPI Number	:	1134183338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS HENRIETTA CRANE PH.D.

Provider Business Mailing Address
First Line	:	14140 BEACH BLVD STE 155
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-4453
Country	:	US
Telephone Number	:	714-896-7556
Fax Number	:

Provider Business Practice Location Address
First Line	:	14140 BEACH BLVD STE 155
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-4453
Country	:	US
Telephone Number	:	714-896-7556
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	03/17/2018

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