Provider Demographics
NPI:1073856332
Name:TRAN, LENA PHUONGHAU (RN, BSN, PHN)
Entity type:Individual
Prefix:MS
First Name:LENA
Middle Name:PHUONGHAU
Last Name:TRAN
Suffix:
Gender:F
Credentials:RN, BSN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18474 TAMARIND ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-5832
Mailing Address - Country:US
Mailing Address - Phone:714-962-3218
Mailing Address - Fax:714-962-3218
Practice Address - Street 1:18474 TAMARIND ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-5832
Practice Address - Country:US
Practice Address - Phone:714-962-3218
Practice Address - Fax:714-962-3218
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA388862163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA388862OtherBOARD OF REGISTERED NURSING