Healthcare Provider Details

I. General information

NPI: 1265683379
Provider Name (Legal Business Name): TRANG M TRAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 04/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 AGUA SARCA CT NE
ALBUQUERQUE NM
87111-5266
US

IV. Provider business mailing address

3515 AGUA SARCA CT NE
ALBUQUERQUE NM
87111-5266
US

V. Phone/Fax

Practice location:
  • Phone: 816-550-8693
  • Fax:
Mailing address:
  • Phone: 816-550-8693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number047056
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: