MEDICARE: ANH TRAN HA

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	163WG0000X	General Practice Registered Nurse	781926	CA
2	163WX0200X	Oncology Registered Nurse	781926	CA
3	363LF0000X	Family Nurse Practitioner	95012927	CA

General Provider Information

NPI Number	:	1871199083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANH TRAN HA

Provider Business Mailing Address
First Line	:	5301 SANDSTONE ST
Second Line	:
City	:	CARMICHAEL
State	:	CA
Zip	:	95608-0625
Country	:	US
Telephone Number	:	916-230-8289
Fax Number	:

Provider Business Practice Location Address
First Line	:	5901 VALLEJO ST
Second Line	:
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-2136
Country	:	US
Telephone Number	:	949-922-9562
Fax Number	:

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

Provider Enumeration Date	:	12/11/2020
Last Update Date	:	12/11/2020

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