Nicolas Lane, ATC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

2081S0010X Issued in CA

Practice address

742 Bonnie Claire Dr
Walnut, CA 91789-4185

Phone

(909) 554-0335

NPI assigned

Jun 21, 2018

Last updated

May 20, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716163200000",
    "number": "1326532417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4373 WHITNEY CT",
            "city": "CHINO",
            "state": "CA",
            "postal_code": "917103963",
            "telephone_number": "909-554-0335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "742 BONNIE CLAIRE DR",
            "city": "WALNUT",
            "state": "CA",
            "postal_code": "917894185",
            "telephone_number": "909-554-0335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE",
        "first_name": "NICOLAS",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-21",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "CA",
            "license": "2081S0010X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Kuo
• Alexandria Alicia Lacayo, MS, ATC
• Jessica Lai
• Karin Sue Lampman, PT
• Chin-Wen Lan
• Stephanie Z. Lane, LCSW
• Carmela Larino, O.D.
• Natalie Yuenching Lau
• Debbie Law, ACUPUNCTURIST
• Giovanni Le, RPH

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Walnut, CA
• Providers in Walnut, CA by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.