Provider Demographics
NPI:1558521310
Name:KATHRYN A. PERRY, D.O., INC.
Entity Type:Organization
Organization Name:KATHRYN A. PERRY, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-592-8399
Mailing Address - Street 1:554 E FOOTHILL BLVD
Mailing Address - Street 2:STE. 120
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1222
Mailing Address - Country:US
Mailing Address - Phone:909-592-8399
Mailing Address - Fax:909-592-8399
Practice Address - Street 1:554 E FOOTHILL BLVD
Practice Address - Street 2:STE. 120
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1222
Practice Address - Country:US
Practice Address - Phone:909-592-8399
Practice Address - Fax:909-592-8399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8577204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty