Provider Demographics
NPI:1164182762
Name:TRAN, LEON (RPH)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:TRAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12441 LA LINDA CIR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92841-3232
Mailing Address - Country:US
Mailing Address - Phone:714-916-2509
Mailing Address - Fax:
Practice Address - Street 1:23975 IRONWOOD AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7153
Practice Address - Country:US
Practice Address - Phone:951-242-1742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85672183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist