Provider Demographics
NPI:1568991289
Name:TRUONG, ON PAO (OTRL)
Entity Type:Individual
Prefix:
First Name:ON
Middle Name:PAO
Last Name:TRUONG
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15454 GALE AVE
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-1500
Mailing Address - Country:US
Mailing Address - Phone:626-330-1538
Mailing Address - Fax:
Practice Address - Street 1:15454 GALE AVE
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-1500
Practice Address - Country:US
Practice Address - Phone:626-330-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist