Provider Demographics
NPI:1164072328
Name:TRAN, NGUYEN (BA)
Entity Type:Individual
Prefix:
First Name:NGUYEN
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:TRAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1350 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-5299
Mailing Address - Country:US
Mailing Address - Phone:909-596-5921
Mailing Address - Fax:
Practice Address - Street 1:1350 3RD ST
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-5299
Practice Address - Country:US
Practice Address - Phone:909-596-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator