Provider Demographics
NPI:1568650216
Name:PERRY, ONISHA CANDISE
Entity Type:Individual
Prefix:
First Name:ONISHA
Middle Name:CANDISE
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N SUTTER ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95202-2412
Mailing Address - Country:US
Mailing Address - Phone:209-467-7744
Mailing Address - Fax:209-467-7755
Practice Address - Street 1:109 N SUTTER ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-2412
Practice Address - Country:US
Practice Address - Phone:209-467-7744
Practice Address - Fax:209-467-7755
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6083810001Medicare NSC