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General NPI Number Information
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NPI Number | 1184234577
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Entity Type | Individual
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Provider Name | TEENA PHAN TRAN NP
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Gender | Female
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Dates
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Enumeration Date | 07/31/2020
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 321 W GARVEY AVE STE A
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City | MONTEREY PARK
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State | CA
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Zip | 91754-7422
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Country | US
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Telephone | 626-695-4276
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Fax |
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Provider Business Mailing Address
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Address Line | 22681 LABRUSCA
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City | MISSION VIEJO
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State | CA
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Zip | 92692-1329
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Country | US
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Telephone | 626-695-4276
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Fax |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP95014956
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License Number State | CA
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