MEDICARE: MS. DELORES 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
1	225400000X	Rehabilitation Practitioner
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1801929583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DELORES LANE

Provider Business Mailing Address
First Line	:	2610 INDUSTRY WAY
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-4028
Country	:	US
Telephone Number	:	310-639-5983
Fax Number	:	310-639-5870

Provider Business Practice Location Address
First Line	:	2610 INDUSTRY WAY
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-4028
Country	:	US
Telephone Number	:	310-639-5983
Fax Number	:	310-639-5870

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	06/21/2013

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Directions to “ MS. DELORES LANE ” Practice Location

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