Provider Demographics
NPI:1962165977
Name:TRAN, REGINA MYRA
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:MYRA
Last Name:TRAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25281 PARK AVE APT L22
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2373
Mailing Address - Country:US
Mailing Address - Phone:714-724-2028
Mailing Address - Fax:
Practice Address - Street 1:22456 BARTON RD
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5009
Practice Address - Country:US
Practice Address - Phone:909-824-2619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85368183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist