Provider Demographics
NPI:1720219751
Name:TRAN, LAURA FONG (AMT)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:FONG
Last Name:TRAN
Suffix:
Gender:F
Credentials:AMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4162 RICHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-2228
Mailing Address - Country:US
Mailing Address - Phone:760-992-6977
Mailing Address - Fax:
Practice Address - Street 1:4162 RICHWOOD AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-2228
Practice Address - Country:US
Practice Address - Phone:760-992-6977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA231038174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist