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General NPI Number Information
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NPI Number | 1790341683
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Entity Type | Individual
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Provider Name | THANHTRUC PHAM TRAN
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Gender | Female
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 05/06/2024
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Provider Practice Location Address
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Address Line | 1011 CAMINO DEL RIO S STE 100
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City | SAN DIEGO
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State | CA
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Zip | 92108-3532
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Country | US
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Telephone | 619-915-6007
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Fax |
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Provider Business Mailing Address
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Address Line | 12773 SEABREEZE FARMS DR UNIT 36
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City | SAN DIEGO
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State | CA
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Zip | 92130-3752
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Country | US
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Telephone | 714-837-3009
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 20070
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License Number State | CA
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