Healthcare Provider Details

I. General information

NPI: 1811802754
Provider Name (Legal Business Name): DIANA TRANNAM DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2123 FOOTHILL BLVD
LA VERNE CA
91750-2954
US

IV. Provider business mailing address

5638 NORWALK CT
RIVERSIDE CA
92505-2322
US

V. Phone/Fax

Practice location:
  • Phone: 909-596-9696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: