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General NPI Number Information
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NPI Number | 1912350190
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Entity Type | Individual
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Provider Name | BRYAN TRAN ATC
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Gender | Male
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Dates
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Enumeration Date | 07/22/2016
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Last Update Date | 07/22/2016
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Provider Practice Location Address
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Address Line | 60 W OLSEN RD LOS ANGELES RAMS/ATHLETIC TRAINING DEPT.
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-2700
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Country | US
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Telephone | 847-912-5629
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Fax |
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Provider Business Mailing Address
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Address Line | 61 N MOUNT PROSPECT RD
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City | DES PLAINES
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State | IL
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Zip | 60016-2263
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Country | US
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Telephone | 847-912-5629
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000012493
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License Number State | IL
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