Provider Demographics
NPI:1083796007
Name:PERKINS, THEION WILLIAMS IV (RN)
Entity Type:Individual
Prefix:MRS
First Name:THEION
Middle Name:WILLIAMS
Last Name:PERKINS
Suffix:IV
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:THEION
Other - Middle Name:WILLIAMS
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:550 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1912
Mailing Address - Country:US
Mailing Address - Phone:213-351-5494
Mailing Address - Fax:213-427-6161
Practice Address - Street 1:550 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1912
Practice Address - Country:US
Practice Address - Phone:213-351-5494
Practice Address - Fax:213-427-6161
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA445154163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult