Provider Demographics
NPI:1760673552
Name:PERKINS, ANGELINA RENEE
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:RENEE
Last Name:PERKINS
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 1:16 RIMCREST CT
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-7357
Mailing Address - Country:US
Mailing Address - Phone:510-541-9586
Mailing Address - Fax:925-458-3935
Practice Address - Street 1:16 RIMCREST CT
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-7357
Practice Address - Country:US
Practice Address - Phone:510-541-9586
Practice Address - Fax:925-458-3935
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18309174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN0505434OtherCA DRIVER LICENSE