=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790550663
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HELEN TRANG TRAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2023
-----------------------------------------------------
Last Update Date | 11/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 W DRUMMOND AVE
-----------------------------------------------------
City | RIDGECREST
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93555-3117
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-653-5913
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13501 DESCANSO DR
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-3208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-653-5913
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | 88827
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------