Provider Demographics
NPI:1356855647
Name:PERESCHICA, HENRY (QUALIFIED MEDICAL IN)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:
Last Name:PERESCHICA
Suffix:
Gender:M
Credentials:QUALIFIED MEDICAL IN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 MARIPOSA ST.
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631
Mailing Address - Country:US
Mailing Address - Phone:559-859-4945
Mailing Address - Fax:559-897-4494
Practice Address - Street 1:221 MARIPOSA ST
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631
Practice Address - Country:US
Practice Address - Phone:559-859-4945
Practice Address - Fax:559-897-4494
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-22
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA179908171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter