Healthcare Provider Details

I. General information

NPI: 1417627159
Provider Name (Legal Business Name): CAROLINE H TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2021
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82151 AVENUE 42 STE 100
INDIO CA
92203-9313
US

IV. Provider business mailing address

82151 AVENUE 42 STE 100
INDIO CA
92203-9313
US

V. Phone/Fax

Practice location:
  • Phone: 442-224-6968
  • Fax:
Mailing address:
  • Phone: 442-224-6968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA62489
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: