MEDICARE: JADE TRAN LMT

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	225700000X	Massage Therapist	85888	CA
2	225700000X	Massage Therapist	8320	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8320	OTHER	LA	MASSAGE LICENSE
2	85888	OTHER	CA	MASSAGE LICENSE

General Provider Information

NPI Number	:	1780252171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JADE TRAN LMT

Provider Business Mailing Address
First Line	:	7711 JORDAN ST
Second Line	:
City	:	MAURICE
State	:	LA
Zip	:	70555-3382
Country	:	US
Telephone Number	:	337-704-7212
Fax Number	:

Provider Business Practice Location Address
First Line	:	7711 JORDAN ST
Second Line	:
City	:	MAURICE
State	:	LA
Zip	:	70555-3382
Country	:	US
Telephone Number	:	337-704-7212
Fax Number	:

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

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	06/14/2021

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Directions to “ JADE TRAN LMT” Practice Location

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