Provider Demographics
NPI:1104169531
Name:TRATT
Entity type:Organization
Organization Name:TRATT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PIC
Authorized Official - Prefix:
Authorized Official - First Name:YU-LING
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:LIAO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-872-0181
Mailing Address - Street 1:1135 S SAN GABRIEL BLVD
Mailing Address - Street 2:#2
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3114
Mailing Address - Country:US
Mailing Address - Phone:626-872-0181
Mailing Address - Fax:626-872-0182
Practice Address - Street 1:1135 S SAN GABRIEL BLVD
Practice Address - Street 2:#2
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3114
Practice Address - Country:US
Practice Address - Phone:626-872-0181
Practice Address - Fax:626-872-0182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-04
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104169531Medicaid