Healthcare Provider Details

I. General information

NPI: 1841521366
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL TRAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12408 HESPERIA RD 2
VICTORVILLE CA
92395-7718
US

IV. Provider business mailing address

12370 HESPERIA RD SUITE 6
VICTORVILLE CA
92395-7719
US

V. Phone/Fax

Practice location:
  • Phone: 760-553-7000
  • Fax:
Mailing address:
  • Phone: 760-245-4747
  • Fax: 760-269-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA20794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: