Basic Information
| Provider Information | |||||||||
| NPI: | 1164182762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRAN | ||||||||
| FirstName: | LEON | ||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12441 LA LINDA CIR | ||||||||
| Address2: | |||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928413232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149162509 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 23975 IRONWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925577153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512421742 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/22/2021 | ||||||||
| LastUpdateDate: | 12/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 85672 | CA | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.