Provider Demographics
NPI:1811322787
Name:TA, TRUC
Entity type:Individual
Prefix:MISS
First Name:TRUC
Middle Name:
Last Name:TA
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:TA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:14121 STENGEL ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4739
Mailing Address - Country:US
Mailing Address - Phone:714-624-0687
Mailing Address - Fax:
Practice Address - Street 1:12440 FIRESTONE BLVD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4328
Practice Address - Country:US
Practice Address - Phone:562-929-6688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor