Healthcare Provider Details

I. General information

NPI: 1649861154
Provider Name (Legal Business Name): STEVE TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1347 MIAMI AVE
CLOVIS CA
93611-3073
US

IV. Provider business mailing address

1347 MIAMI AVE
CLOVIS CA
93611-3073
US

V. Phone/Fax

Practice location:
  • Phone: 559-930-3729
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number69978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: