Provider Demographics
NPI:1306002878
Name:TRAN, AUTUMN THU
Entity Type:Individual
Prefix:MISS
First Name:AUTUMN
Middle Name:THU
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 MISSION DR APT 1
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4226
Mailing Address - Country:US
Mailing Address - Phone:714-979-6439
Mailing Address - Fax:
Practice Address - Street 1:970 MISSION DR APT 1
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4226
Practice Address - Country:US
Practice Address - Phone:714-979-6439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program