=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225733793
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID QUOC TRAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2023
-----------------------------------------------------
Last Update Date | 04/03/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8985 MIRA MESA BLVD
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92126-2716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-566-3490
-----------------------------------------------------
Fax | 858-566-2979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10879 WORTHING AVE
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92126-2220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-204-0286
-----------------------------------------------------
Fax | 858-566-2979
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | TCH14137
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------