Healthcare Provider Details

I. General information

NPI: 1629441084
Provider Name (Legal Business Name): TRACY HONG TRAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2015
Last Update Date: 11/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 ROBINSON AVE
SAN DIEGO CA
92103-4209
US

IV. Provider business mailing address

12504 OAK KNOLL RD APT 13
POWAY CA
92064-5467
US

V. Phone/Fax

Practice location:
  • Phone: 619-291-3705
  • Fax: 619-291-8502
Mailing address:
  • Phone: 858-380-9120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number73776
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: