Healthcare Provider Details

I. General information

NPI: 1881019818
Provider Name (Legal Business Name): POSITIVE HEALTHY AGING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23521 PASEO DE VALENCIA SUITE 311
LAGUNA HILLS CA
92653-3107
US

IV. Provider business mailing address

23521 PASEO DE VALENCIA SUITE 311
LAGUNA HILLS CA
92653-3107
US

V. Phone/Fax

Practice location:
  • Phone: 949-305-2660
  • Fax: 949-305-2036
Mailing address:
  • Phone: 949-305-2660
  • Fax: 949-305-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA85461
License Number StateCA

VIII. Authorized Official

Name: DR. ROGER TRAN
Title or Position: PRESIDENT
Credential:
Phone: 949-305-2660