Provider Demographics
NPI:1164878773
Name:TRAN, DUONG (NP)
Entity Type:Individual
Prefix:
First Name:DUONG
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10333 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-5808
Mailing Address - Country:US
Mailing Address - Phone:805-468-2000
Mailing Address - Fax:
Practice Address - Street 1:325 POSADA LN
Practice Address - Street 2:A
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4003
Practice Address - Country:US
Practice Address - Phone:805-542-6700
Practice Address - Fax:805-542-6791
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2023-09-29
Deactivation Date:2023-09-15
Deactivation Code:
Reactivation Date:2023-09-21
Provider Licenses
StateLicense IDTaxonomies
CA95004335363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology