Provider Demographics
NPI:1811261084
Name:LANE, ANAIS DANIELLE (NP)
Entity type:Individual
Prefix:MS
First Name:ANAIS
Middle Name:DANIELLE
Last Name:LANE
Suffix:
Gender:F
Credentials:NP
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Other - Credentials:
Mailing Address - Street 1:18000 STUDEBAKER RD STE 800
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2671
Mailing Address - Country:US
Mailing Address - Phone:562-735-3226
Mailing Address - Fax:
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5025
Practice Address - Country:US
Practice Address - Phone:562-869-1201
Practice Address - Fax:562-869-1281
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2018-11-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA21647363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811261084Medicaid