Healthcare Provider Details

I. General information

NPI: 1609519313
Provider Name (Legal Business Name): VICTORIA TRAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2022
Last Update Date: 10/18/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 AMERICAS PKWY NE STE 200
ALBUQUERQUE NM
87110-8172
US

IV. Provider business mailing address

1200 N WHITE SANDS BLVD STE 115
ALAMOGORDO NM
88310-6774
US

V. Phone/Fax

Practice location:
  • Phone: 866-273-2451
  • Fax:
Mailing address:
  • Phone: 866-273-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0222331
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: