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NPI Code Detail

MEDICARE: MS. DYMIKA M LANE

MEDICARE: MS. DYMIKA M LANE
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
1104100000XSocial Worker
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1346318037
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DYMIKA M LANE
Provider Business Mailing Address
First Line : 1908 BUSINESS CENTER DR STE 220
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92408-3468
Country : US
Telephone Number : 909-890-5930
Fax Number :
Provider Business Practice Location Address
First Line : 1908 BUSINESS CENTER DR STE 220
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92408-3468
Country : US
Telephone Number : 909-890-5930
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2006
Last Update Date : 06/21/2013

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