Provider Demographics
NPI:1841011517
Name:TRAN, TRISTAN THANH
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:THANH
Last Name:TRAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 SAN FELIPE STREET
Mailing Address - Street 2:SUITE 990
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063
Mailing Address - Country:US
Mailing Address - Phone:866-610-0580
Mailing Address - Fax:866-611-1558
Practice Address - Street 1:1835 PARK AVE
Practice Address - Street 2:#3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126
Practice Address - Country:US
Practice Address - Phone:408-885-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician