Provider Demographics
NPI:1275703787
Name:VANE, DYLAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DYLAN
Middle Name:
Last Name:VANE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 E NEES AVE APT 133
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0933
Mailing Address - Country:US
Mailing Address - Phone:415-707-9837
Mailing Address - Fax:
Practice Address - Street 1:2200 W 3RD ST STE 500
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1938
Practice Address - Country:US
Practice Address - Phone:415-252-1853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY34980103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical