Provider Demographics
NPI:1215133533
Name:PERRY, TARA (LAC & DA)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LAC & DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S BEVERLY DR STE 108
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4804
Mailing Address - Country:US
Mailing Address - Phone:310-586-9737
Mailing Address - Fax:310-828-7268
Practice Address - Street 1:300 S BEVERLY DR STE 108
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4804
Practice Address - Country:US
Practice Address - Phone:310-586-9737
Practice Address - Fax:310-828-7268
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5559171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist