Healthcare Provider Details

I. General information

NPI: 1477360386
Provider Name (Legal Business Name): MICHELLE HUYNH TRANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26891 ALISO CREEK RD
ALISO VIEJO CA
92656-3392
US

IV. Provider business mailing address

10330 E BRIAR OAKS DR APT D
STANTON CA
90680-4229
US

V. Phone/Fax

Practice location:
  • Phone: 949-360-4081
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number90323
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: