Provider Demographics
NPI:1225098171
Name:PERRY, JULIE A (PAC)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:PERRY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 PASEO DEL NORTE STE 110
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1113
Mailing Address - Country:US
Mailing Address - Phone:760-795-8900
Mailing Address - Fax:760-795-8901
Practice Address - Street 1:6125 PASEO DEL NORTE STE 110
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-1113
Practice Address - Country:US
Practice Address - Phone:760-795-8900
Practice Address - Fax:760-795-8901
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4184363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7188BMedicare ID - Type Unspecified
P23597Medicare UPIN