Provider Demographics
NPI:1114392081
Name:LANE, KALAYA
Entity Type:Individual
Prefix:
First Name:KALAYA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8370 E NORTHFIELD BLVD
Mailing Address - Street 2:UNIT 1775
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3132
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8370 E NORTHFIELD BLVD
Practice Address - Street 2:UNIT 1775
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-3132
Practice Address - Country:US
Practice Address - Phone:303-574-0150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-03
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0017836174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist