Provider Demographics
NPI:1972961233
Name:TRUONG, AN (MS, ATC, CSCS D)
Entity type:Individual
Prefix:
First Name:AN
Middle Name:
Last Name:TRUONG
Suffix:
Gender:M
Credentials:MS, ATC, CSCS D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 S MCDOWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-5434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3855 CYPRESS DR
Practice Address - Street 2:SUITE A
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954-5600
Practice Address - Country:US
Practice Address - Phone:707-766-4096
Practice Address - Fax:866-223-6598
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-02
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0699026252255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer