Provider Demographics
NPI:1780618256
Name:PERRY, KATHRYN A (DO)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:A
Last Name:PERRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:816 MAIN ST
Mailing Address - Street 2:STE. D
Mailing Address - City:CAMBRIA
Mailing Address - State:CA
Mailing Address - Zip Code:93428-2824
Mailing Address - Country:US
Mailing Address - Phone:805-548-8490
Mailing Address - Fax:805-548-8491
Practice Address - Street 1:816 MAIN ST
Practice Address - Street 2:STE. D
Practice Address - City:CAMBRIA
Practice Address - State:CA
Practice Address - Zip Code:93428-2824
Practice Address - Country:US
Practice Address - Phone:805-548-8490
Practice Address - Fax:805-548-8491
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8577207Q00000X, 204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I64571Medicare UPIN