Provider Demographics
NPI:1346894292
Name:PEROVICH, ASPEN (PA-C, MS, RDN)
Entity Type:Individual
Prefix:
First Name:ASPEN
Middle Name:
Last Name:PEROVICH
Suffix:
Gender:F
Credentials:PA-C, MS, RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11905 SILVER CLIFF WAY
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670-8397
Mailing Address - Country:US
Mailing Address - Phone:505-550-5989
Mailing Address - Fax:
Practice Address - Street 1:4350 E RAY RD STE 101A
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-4707
Practice Address - Country:US
Practice Address - Phone:480-704-5954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM978266133V00000X
CAPA63653363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered