Healthcare Provider Details

I. General information

NPI: 1073106936
Provider Name (Legal Business Name): TIFFANY V TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 EMBARCADERO STE 400
OAKLAND CA
94606-5300
US

IV. Provider business mailing address

2635 42ND AVE
SAN FRANCISCO CA
94116-2715
US

V. Phone/Fax

Practice location:
  • Phone: 510-567-8101
  • Fax:
Mailing address:
  • Phone: 415-341-7945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: