Provider Demographics
NPI:1225733793
Name:TRAN, DAVID QUOC
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:QUOC
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10879 WORTHING AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2220
Mailing Address - Country:US
Mailing Address - Phone:858-204-0286
Mailing Address - Fax:858-566-2979
Practice Address - Street 1:8985 MIRA MESA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2716
Practice Address - Country:US
Practice Address - Phone:858-566-3490
Practice Address - Fax:858-566-2979
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CATCH14137183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician