Provider Demographics
NPI:1659737492
Name:TRUONG, JASMINE NGOC (PTA)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:NGOC
Last Name:TRUONG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 S MANITOBA DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6637
Mailing Address - Country:US
Mailing Address - Phone:714-334-8902
Mailing Address - Fax:
Practice Address - Street 1:215 N STATE COLLEGE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-2913
Practice Address - Country:US
Practice Address - Phone:714-999-5009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-09
Last Update Date:2016-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT11208225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant