Provider Demographics
NPI:1730210923
Name:LANE, ALEJANDRA (MA)
Entity type:Individual
Prefix:
First Name:ALEJANDRA
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:474 W VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6584
Mailing Address - Country:US
Mailing Address - Phone:626-484-3291
Mailing Address - Fax:
Practice Address - Street 1:474 W VERMONT AVE
Practice Address - Street 2:STE. 104
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-6584
Practice Address - Country:US
Practice Address - Phone:760-294-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAENK1800OtherLA DEPT. OF MENTAL HEALTH