Provider Demographics
NPI:1417182189
Name:PERRELLI, ANDY PAUL (PTA)
Entity Type:Individual
Prefix:MR
First Name:ANDY
Middle Name:PAUL
Last Name:PERRELLI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29187 FLOWERPARK DR
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387-4406
Mailing Address - Country:US
Mailing Address - Phone:661-236-7836
Mailing Address - Fax:
Practice Address - Street 1:29187 FLOWERPARK DR
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-4406
Practice Address - Country:US
Practice Address - Phone:661-236-7836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-23
Last Update Date:2009-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT1120282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital