Healthcare Provider Details

I. General information

NPI: 1023149408
Provider Name (Legal Business Name): VICTORIA K TRAHAN RN, MED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 N 44TH ST
PHOENIX AZ
85018-5420
US

IV. Provider business mailing address

3811 N 44TH ST
PHOENIX AZ
85018-5420
US

V. Phone/Fax

Practice location:
  • Phone: 480-484-6209
  • Fax: 480-484-6228
Mailing address:
  • Phone: 480-484-6209
  • Fax: 480-484-6228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN030303
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: