Healthcare Provider Details

I. General information

NPI: 1598563553
Provider Name (Legal Business Name): ANTHONY TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 E CANYON RIM RD STE 113E
ANAHEIM CA
92807-4317
US

IV. Provider business mailing address

2205 PEPPERWOOD LN
CORONA CA
92882-3790
US

V. Phone/Fax

Practice location:
  • Phone: 714-974-0330
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number307684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: