Provider Demographics
NPI:1780812420
Name:PERRIN, GINETTE DENISE (PSYD)
Entity type:Individual
Prefix:DR
First Name:GINETTE
Middle Name:DENISE
Last Name:PERRIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28936 OLD TOWN FRONT ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2890
Mailing Address - Country:US
Mailing Address - Phone:619-955-2059
Mailing Address - Fax:760-645-7059
Practice Address - Street 1:28936 OLD TOWN FRONT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2890
Practice Address - Country:US
Practice Address - Phone:619-955-2059
Practice Address - Fax:760-645-7059
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22749103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical