Healthcare Provider Details

I. General information

NPI: 1699594002
Provider Name (Legal Business Name): ERIC TRAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18529 CALVERT ST APT 305
TARZANA CA
91335-7385
US

IV. Provider business mailing address

18529 CALVERT ST APT 305
TARZANA CA
91335-7385
US

V. Phone/Fax

Practice location:
  • Phone: 312-898-8632
  • Fax:
Mailing address:
  • Phone: 312-898-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number307211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: