Healthcare Provider Details

I. General information

NPI: 1992594642
Provider Name (Legal Business Name): COLEY T RANSAW PA-S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2025
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18220 YORBA LINDA BLVD STE 301
YORBA LINDA CA
92886-4032
US

IV. Provider business mailing address

2727 N MAIN PLACE DR UNIT 416
SANTA ANA CA
92705-6062
US

V. Phone/Fax

Practice location:
  • Phone: 714-599-8084
  • Fax: 714-572-2562
Mailing address:
  • Phone: 504-915-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number67263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: