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General NPI Number Information
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NPI Number | 1043216179
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Entity Type | Individual
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Provider Name | CAROL TRAN PA
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Gender | Female
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Dates
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Enumeration Date | 06/23/2005
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Last Update Date | 05/07/2024
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Provider Practice Location Address
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Address Line | 3810 MASTHEAD ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4479
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Country | US
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Telephone | 58-438-7585
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Fax | 505-843-8759
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Provider Business Mailing Address
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Address Line | 3810 MASTHEAD ST NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-4479
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Country | US
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Telephone | 505-843-8758
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Fax | 505-843-8759
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2016-0057
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA04560
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License Number State | TX
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