Healthcare Provider Details

I. General information

NPI: 1225350135
Provider Name (Legal Business Name): HOAI TRAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2010
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 TERRACINA BLVD
REDLANDS CA
92373-4847
US

IV. Provider business mailing address

1801 ORANGE TREE LN STE 200
REDLANDS CA
92374-4587
US

V. Phone/Fax

Practice location:
  • Phone: 909-793-2634
  • Fax: 909-798-8749
Mailing address:
  • Phone: 909-557-1607
  • Fax: 909-557-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: