Provider Demographics
NPI:1790975969
Name:PERISHO, KARLA MARGUERITE (FNP)
Entity Type:Individual
Prefix:MS
First Name:KARLA
Middle Name:MARGUERITE
Last Name:PERISHO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:MARGUERITE
Other - Last Name:PARSONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:100 FALLS CANYON ROAD
Mailing Address - Street 2:P.O. BOX 1583
Mailing Address - City:AVALON
Mailing Address - State:CA
Mailing Address - Zip Code:90704
Mailing Address - Country:US
Mailing Address - Phone:310-510-0096
Mailing Address - Fax:310-510-2381
Practice Address - Street 1:100 FALLS CANYON ROAD
Practice Address - Street 2:
Practice Address - City:AVALON
Practice Address - State:CA
Practice Address - Zip Code:90704
Practice Address - Country:US
Practice Address - Phone:310-510-0096
Practice Address - Fax:310-510-2381
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA459718363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP42792Medicare UPIN