Basic Information
| Provider Information | |||||||||
| NPI: | 1275296915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRANE | ||||||||
| FirstName: | COLIN | ||||||||
| MiddleName: | MANUEL | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6329 AVON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN GABRIEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917751801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3054842317 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2575 YORBA LINDA BLVD | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928311699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144497400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2021 | ||||||||
| LastUpdateDate: | 03/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA60525 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 390200000X | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.