Healthcare Provider Details

I. General information

NPI: 1992390272
Provider Name (Legal Business Name): AMANDA TRAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SUPERIOR AVE STE 150
NEWPORT BEACH CA
92663-3642
US

IV. Provider business mailing address

4828 CYPRESS ST UNIT 404
MONTCLAIR CA
91763-1443
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-8065
  • Fax:
Mailing address:
  • Phone: 408-375-5354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number78797
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number78797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: