Provider Demographics
NPI:1497259253
Name:TRAN, CECILIA DOAN PHUNG
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:DOAN PHUNG
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 1:2121 RIDGELAKE DR FL 3
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-2080
Mailing Address - Country:US
Mailing Address - Phone:504-325-2700
Mailing Address - Fax:
Practice Address - Street 1:2121 RIDGELAKE DR FL 3
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-2080
Practice Address - Country:US
Practice Address - Phone:504-325-2700
Practice Address - Fax:504-249-5527
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA1497259253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program