MEDICARE: VIVI JENNIFER TRAN FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	95030572	CA

General Provider Information

NPI Number	:	1184450215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVI JENNIFER TRAN FNP-BC

Provider Business Mailing Address
First Line	:	2077 HARBOR BLVD STE A
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-9384
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2077 HARBOR BLVD STE A
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-9384
Country	:	US
Telephone Number	:	714-602-7805
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2024
Last Update Date	:	09/18/2024

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