Provider Demographics
NPI:1972045755
Name:TRUONG, LOAN TO
Entity Type:Individual
Prefix:
First Name:LOAN
Middle Name:TO
Last Name:TRUONG
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 1:8193 OAKBRIAR CIR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7937
Mailing Address - Country:US
Mailing Address - Phone:916-425-6931
Mailing Address - Fax:
Practice Address - Street 1:8193 OAKBRIAR CIR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7937
Practice Address - Country:US
Practice Address - Phone:916-425-6931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health