Provider Demographics
NPI:1558149336
Name:TRAN, THANH QUOC (LVN)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:QUOC
Last Name:TRAN
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EDGEMOOR DPSNF
Mailing Address - Street 2:655 PARK CENTER DRIVE
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-6957
Mailing Address - Country:US
Mailing Address - Phone:619-596-5500
Mailing Address - Fax:619-596-5501
Practice Address - Street 1:EDGEMOOR DPSNF
Practice Address - Street 2:655 PARK CENTER DRIVE
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-6957
Practice Address - Country:US
Practice Address - Phone:619-596-5500
Practice Address - Fax:619-596-5501
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN735330164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse