Provider Demographics
NPI:1922542265
Name:PERKINS, CARLA (RDA)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:PERKINS
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 WEST JEFFERSON BLVD.
Mailing Address - Street 2:APT 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2954
Mailing Address - Country:US
Mailing Address - Phone:323-798-2542
Mailing Address - Fax:
Practice Address - Street 1:9910 LONG BEACH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-1561
Practice Address - Country:US
Practice Address - Phone:323-563-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46339126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant