Individual
NATHANIEL GANDY LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
420 S. BRISTOL ST., SANTA ANA, CA 92703
(714) 541-5252
Mailing address
420 S BRISTOL ST, SANTA ANA, CA 92703-4527
(714) 541-5252
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
53182
CA
Other
Enumeration date
02/15/2016
Last updated
02/15/2016
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