Healthcare Provider Details

I. General information

NPI: 1467635094
Provider Name (Legal Business Name): PAULA TRAN IMOTO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9985 SIERRA AVE
FONTANA CA
92335-5825
US

IV. Provider business mailing address

5822 MYDA AVE
TEMPLE CITY CA
91780
US

V. Phone/Fax

Practice location:
  • Phone: 888-750-0036
  • Fax:
Mailing address:
  • Phone: 626-226-8710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13283T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: