Healthcare Provider Details

I. General information

NPI: 1376376186
Provider Name (Legal Business Name): DONNA TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3002 DOW AVE STE 206
TUSTIN CA
92780-7234
US

IV. Provider business mailing address

3002 DOW AVE STE 206
TUSTIN CA
92780-7234
US

V. Phone/Fax

Practice location:
  • Phone: 657-294-5113
  • Fax: 657-294-5114
Mailing address:
  • Phone: 657-294-5113
  • Fax: 657-294-5114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: