Provider Demographics
NPI:1043216179
Name:TRAN, CAROL (PA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6500 JEFFERSON ST NE
Mailing Address - Street 2:STE 100
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3486
Mailing Address - Country:US
Mailing Address - Phone:505-843-8758
Mailing Address - Fax:505-843-8759
Practice Address - Street 1:3619 PAESANOS PKWY
Practice Address - Street 2:STE 212
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78231-1253
Practice Address - Country:US
Practice Address - Phone:210-690-5599
Practice Address - Fax:210-690-5595
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA04560363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00298578OtherRAILROAD MEDICARE
TX840878OtherBCBS
P96464Medicare UPIN
TXP00298578Medicare PIN
P00298578OtherRAILROAD MEDICARE
TX8G2256Medicare PIN