Provider Demographics
NPI:1427178946
Name:LANE, ROBERT A (CCP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:LANE
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 N JACKSON ST
Mailing Address - Street 2:APT D.
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4327
Mailing Address - Country:US
Mailing Address - Phone:818-243-7657
Mailing Address - Fax:
Practice Address - Street 1:123 N JACKSON ST
Practice Address - Street 2:APT D.
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4327
Practice Address - Country:US
Practice Address - Phone:818-243-7657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular