Provider Demographics
NPI:1114699618
Name:TRUONG, ADELAIDE (PA)
Entity Type:Individual
Prefix:
First Name:ADELAIDE
Middle Name:
Last Name:TRUONG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17393
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92817-7393
Mailing Address - Country:US
Mailing Address - Phone:714-261-6249
Mailing Address - Fax:
Practice Address - Street 1:24160 RANCHO SANTA ANA RD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-5632
Practice Address - Country:US
Practice Address - Phone:714-261-6249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant