Provider Demographics
NPI:1023648201
Name:CRANE, PAMELA RENEA (C-IAYT, MS)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:RENEA
Last Name:CRANE
Suffix:
Gender:F
Credentials:C-IAYT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 MEADE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-4519
Mailing Address - Country:US
Mailing Address - Phone:501-952-2950
Mailing Address - Fax:
Practice Address - Street 1:3237 MEADE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-4519
Practice Address - Country:US
Practice Address - Phone:501-952-2950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No174400000XOther Service ProvidersSpecialist
No174H00000XOther Service ProvidersHealth Educator