Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CP003504 | CA |
NPI | 1093952178 |
---|---|
Provider Name | Mr. Minh Q. Tran |
First Address | Loma Linda, CA 92354-3711 |
Second Address | Loma Linda, CA 92354-3711 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2009 |
Last Update Date | 12/01/2009 |