Healthcare Provider Details

I. General information

NPI: 1609552199
Provider Name (Legal Business Name): YLAN-NIKKI NGOC TRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 N MOPAC EXPY STE 3-210
AUSTIN TX
78759-8859
US

IV. Provider business mailing address

15220 CALAVERAS DR
AUSTIN TX
78717-4635
US

V. Phone/Fax

Practice location:
  • Phone: 512-341-1000
  • Fax:
Mailing address:
  • Phone: 512-971-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: