Healthcare Provider Details

I. General information

NPI: 1417440272
Provider Name (Legal Business Name): NAM TRAN AVO HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W HOSPITALITY LN STE 210
SN BERNRDNO CA
92408-3211
US

IV. Provider business mailing address

325 W HOSPITALITY LN STE 210
SAN BERNARDINO CA
92408-3211
US

V. Phone/Fax

Practice location:
  • Phone: 951-268-2535
  • Fax: 951-268-9127
Mailing address:
  • Phone: 951-268-2535
  • Fax: 951-268-9127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA8338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: