Provider Demographics
NPI:1831589837
Name:TRAN, THUY TRAM THI
Entity type:Individual
Prefix:
First Name:THUY TRAM
Middle Name:THI
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 1:524 S CINNAMON WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-3359
Mailing Address - Country:US
Mailing Address - Phone:714-244-7074
Mailing Address - Fax:
Practice Address - Street 1:15606 BROOKHURST ST STE B
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7582
Practice Address - Country:US
Practice Address - Phone:714-531-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001952363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner