Provider Demographics
NPI:1124276209
Name:PERRY, CAROLYN MARIE (PA-C)
Entity type:Individual
Prefix:MISS
First Name:CAROLYN
Middle Name:MARIE
Last Name:PERRY
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 1:1401 AVOCADO AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7720
Mailing Address - Country:US
Mailing Address - Phone:949-720-1944
Mailing Address - Fax:949-720-9710
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-720-1944
Practice Address - Fax:949-720-9710
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19869363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical