Healthcare Provider Details

I. General information

NPI: 1174035349
Provider Name (Legal Business Name): KEVIN MINH TRAN-MORTEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date: 05/30/2024
Reactivation Date: 07/03/2024

III. Provider practice location address

1330 ARNOLD DR STE 140
MARTINEZ CA
94553-6538
US

IV. Provider business mailing address

1330 ARNOLD DR STE 140
MARTINEZ CA
94553-6538
US

V. Phone/Fax

Practice location:
  • Phone: 925-944-2244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: