Provider Demographics
NPI:1821378068
Name:LANE, THERESA BARCARSE (STUDENT)
Entity type:Individual
Prefix:MISS
First Name:THERESA
Middle Name:BARCARSE
Last Name:LANE
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 CORPORATE DR APT 527
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1114
Mailing Address - Country:US
Mailing Address - Phone:949-228-1463
Mailing Address - Fax:
Practice Address - Street 1:835 3RD AVENUE, SUITE C
Practice Address - Street 2:COMMUNITY RESEARCH FOUNDATION
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911
Practice Address - Country:US
Practice Address - Phone:619-427-4661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-19
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program