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NPI 1588914501

NPI 1588914501 : CHERYL TRAN : SAN DIMAS, CA

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General NPI Number Information
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    NPI Number           |    1588914501
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    Entity Type          |    Individual 
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    Provider Name        |    CHERYL TRAN
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    09/17/2012
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    Last Update Date     |    09/17/2012
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Provider Practice Location Address
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    Address Line         |    1036 AVENIDA LOMITA 
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    City                 |    SAN DIMAS
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    State                |    CA
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    Zip                  |    91773-4309
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    Country              |    US
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    Telephone            |    626-688-7348
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    1036 AVENIDA LOMITA 
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    City                 |    SAN DIMAS
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    State                |    CA
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    Zip                  |    91773-4309
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    Country              |    US
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    Telephone            |    
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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        |    225X00000X
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    Taxonomy Name        |    Occupational Therapist
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    License Number       |    10875
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    License Number State |    CA
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