MEDICARE: MR. QUANG TRAN M.A.,BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-13-13136	CA

General Provider Information

NPI Number	:	1619210788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. QUANG TRAN M.A.,BCBA

Provider Business Mailing Address
First Line	:	5511 ALLOTT AVE
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5511 ALLOTT AVE
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91401-5222
Country	:	US
Telephone Number	:	818-901-2695
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2013
Last Update Date	:	03/27/2013

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