Provider Demographics
NPI:1972229854
Name:PERDOMO, ANA JASMIN
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:JASMIN
Last Name:PERDOMO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 PACKARD AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:95901-7119
Mailing Address - Country:US
Mailing Address - Phone:916-953-8566
Mailing Address - Fax:
Practice Address - Street 1:5730 PACKARD AVE STE 500
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-7119
Practice Address - Country:US
Practice Address - Phone:916-953-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022990363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care