Provider Demographics
NPI:1467194522
Name:TRAN, MARISA DANIELLE (MD)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:DANIELLE
Last Name:TRAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 EUREKA RD
Mailing Address - Street 2:ATTN: EMERGENCY DEPARTMENT
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-474-6342
Mailing Address - Fax:916-474-6351
Practice Address - Street 1:1600 EUREKA RD
Practice Address - Street 2:ATTN: EMERGENCY DEPARTMENT
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3027
Practice Address - Country:US
Practice Address - Phone:916-474-6342
Practice Address - Fax:916-474-6351
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-10
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA200689207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program