Healthcare Provider Details

I. General information

NPI: 1255892683
Provider Name (Legal Business Name): STEPHANIE TRAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 N 1ST ST STE 131
FRESNO CA
93710-3947
US

IV. Provider business mailing address

2285 CORPORATE CIR STE 200
HENDERSON NV
89074-7759
US

V. Phone/Fax

Practice location:
  • Phone: 559-432-3333
  • Fax: 559-432-3336
Mailing address:
  • Phone: 702-360-2763
  • Fax: 949-783-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA57210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: