Provider Demographics
NPI:1164641643
Name:TRAN, JESSICA (ND)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14795 JEFFREY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-0415
Mailing Address - Country:US
Mailing Address - Phone:949-612-6371
Mailing Address - Fax:
Practice Address - Street 1:2 ANZIO
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-7309
Practice Address - Country:US
Practice Address - Phone:949-612-6371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05-900175F00000X
CAND-396175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath