Provider Demographics
NPI:1003226952
Name:TRAN, LEILANI
Entity Type:Individual
Prefix:
First Name:LEILANI
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 CAMINO DE LA LUNA
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-2991
Mailing Address - Country:US
Mailing Address - Phone:484-620-5073
Mailing Address - Fax:
Practice Address - Street 1:404 E 4TH ST
Practice Address - Street 2:
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92570-2201
Practice Address - Country:US
Practice Address - Phone:951-943-1575
Practice Address - Fax:951-943-1577
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist