MEDICARE: MISS AKILA CRANE MBA

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	172A00000X	Driver	B7667621	CA

General Provider Information

NPI Number	:	1568999738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AKILA CRANE MBA

Provider Business Mailing Address
First Line	:	PO BOX 52258
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92517-3258
Country	:	US
Telephone Number	:	951-907-6820
Fax Number	:

Provider Business Practice Location Address
First Line	:	4253 KANSAS AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-5151
Country	:	US
Telephone Number	:	951-907-6820
Fax Number	:	951-907-6820

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

Provider Enumeration Date	:	05/17/2017
Last Update Date	:	05/17/2017

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