Healthcare Provider Details

I. General information

NPI: 1114247616
Provider Name (Legal Business Name): MONGDAO TRAN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2010
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32121 CAMINO CAPISTRANO
SAN JUAN CAPISTRANO CA
92675-3716
US

IV. Provider business mailing address

16526 SUGARLOAF ST
FOUNTAIN VALLEY CA
92708-2454
US

V. Phone/Fax

Practice location:
  • Phone: 949-493-2178
  • Fax: 949-493-9679
Mailing address:
  • Phone: 714-702-4104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number54905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: