Healthcare Provider Details

I. General information

NPI: 1821708199
Provider Name (Legal Business Name): LISA TRAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SANDPOINTE AVE STE 130
SANTA ANA CA
92707-5785
US

IV. Provider business mailing address

14932 VAN BUREN ST APT B
MIDWAY CITY CA
92655-1289
US

V. Phone/Fax

Practice location:
  • Phone: 714-557-9292
  • Fax:
Mailing address:
  • Phone: 714-603-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number303259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: