Provider Demographics
NPI:1790963502
Name:PERISSINOTTO, CARLA MARIA (MD, MHS)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:MARIA
Last Name:PERISSINOTTO
Suffix:
Gender:F
Credentials:MD, MHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 ILLINOIS ST FL 8
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2510
Mailing Address - Country:US
Mailing Address - Phone:415-476-6188
Mailing Address - Fax:
Practice Address - Street 1:490 ILLINOIS ST FL 8
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2510
Practice Address - Country:US
Practice Address - Phone:415-476-6188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102634207R00000X, 207RH0002X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine