Individual
NICOLAS LANE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
742 BONNIE CLAIRE DR, WALNUT, CA 91789-4185
(909) 554-0335
Mailing address
4373 WHITNEY CT, CHINO, CA 91710-3963
(909) 554-0335
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
2081S0010X
CA
Other
Enumeration date
06/21/2018
Last updated
05/20/2024
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