Healthcare Provider Details

I. General information

NPI: 1740500404
Provider Name (Legal Business Name): MAI-HUE THI TRAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1363 E VISTA WAY
VISTA CA
92084-4041
US

IV. Provider business mailing address

4153 BRYAN ST
OCEANSIDE CA
92056-3438
US

V. Phone/Fax

Practice location:
  • Phone: 760-726-1909
  • Fax: 760-726-6568
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number52270
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: