Most Relevant Information
Provider Data
| NPI Number: | 1003311200 |
| Provider Name: | MALCOLM JAMAAL LANE |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/28/2018 |
| Last Updated: | 03/28/2018 |
Provider Practice Location
75 E SANTA CLARA ST
SAN JOSE
CA
951131827
Practice Location Phone/Fax
| Phone: | 8662271211 |
| Fax: |
Provider Mailing Location
32530 PULASKI DR
HAYWARD
CA
945448223
Provider Mailing Phone/Fax
| Phone: | 5103313307 |
| Fax: |