Provider Demographics
NPI:1992921399
Name:PERRY, DALE R (CFNP)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:R
Last Name:PERRY
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8929 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2009
Mailing Address - Country:US
Mailing Address - Phone:310-422-3179
Mailing Address - Fax:310-558-8285
Practice Address - Street 1:8929 W 24TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-2009
Practice Address - Country:US
Practice Address - Phone:310-422-3179
Practice Address - Fax:310-558-8285
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily