Individual
MRS. JENNIFER LAUREN LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2876 SYCAMORE DR, SIMI VALLEY, CA 93065-1530
(805) 527-6424
Mailing address
20516 GERMAIN ST, CHATSWORTH, CA 91311-2417
(951) 750-9051
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
54157
CA
Other
Enumeration date
01/13/2017
Last updated
02/15/2018
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