Healthcare Provider Details

I. General information

NPI: 1205741626
Provider Name (Legal Business Name): PATRISHA TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2087 HOTEL CIR S
SAN DIEGO CA
92108-3313
US

IV. Provider business mailing address

3273 KEARNY VILLA LN
SAN DIEGO CA
92123-1910
US

V. Phone/Fax

Practice location:
  • Phone: 619-717-2363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-MVEKPW
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: