Provider Demographics
NPI:1811045263
Name:PERLMAN, VIVIAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:
Last Name:PERLMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8415 N PIMA RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4483
Mailing Address - Country:US
Mailing Address - Phone:480-977-6844
Mailing Address - Fax:480-977-6845
Practice Address - Street 1:8415 N PIMA RD STE 150
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4483
Practice Address - Country:US
Practice Address - Phone:480-977-6844
Practice Address - Fax:480-977-6845
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2853363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ878035Medicaid
AZ878035Medicaid