Healthcare Provider Details

I. General information

NPI: 1134556137
Provider Name (Legal Business Name): STANLY TRAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2013
Last Update Date: 05/25/2021
Certification Date: 04/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 HOWARD WAY STE 150
COSTA MESA CA
92626-1496
US

IV. Provider business mailing address

1095 IRVINE BLVD
TUSTIN CA
92780-3526
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-9227
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: