Provider Demographics
NPI:1750675880
Name:CRANE, AMANDA (RD, CLT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:CRANE
Suffix:
Gender:F
Credentials:RD, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11093 DEL DIABLO ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-1504
Mailing Address - Country:US
Mailing Address - Phone:619-972-3870
Mailing Address - Fax:858-672-0661
Practice Address - Street 1:11093 DEL DIABLO ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-1504
Practice Address - Country:US
Practice Address - Phone:619-972-3870
Practice Address - Fax:858-672-0661
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT00925602133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered