Provider Demographics
NPI:1639718513
Name:TRAN, EMILIE
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:TRAN
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 1:478 CALERO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-4211
Mailing Address - Country:US
Mailing Address - Phone:408-796-8740
Mailing Address - Fax:
Practice Address - Street 1:2570 48TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1541
Practice Address - Country:US
Practice Address - Phone:408-796-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-25
Last Update Date:2024-06-10
Deactivation Date:2024-05-28
Deactivation Code:
Reactivation Date:2024-06-10
Provider Licenses
StateLicense IDTaxonomies
CA46-1305562106S00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician