MEDICARE: MARY ELIZABETH PERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath

General Provider Information

NPI Number	:	1578997797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH PERRY

Provider Business Mailing Address
First Line	:	1544 GRANVILLE AVE
Second Line	:	SUITE 302
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2891
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1544 GRANVILLE AVE
Second Line	:	SUITE 302
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2891
Country	:	US
Telephone Number	:	954-746-8232
Fax Number	:	954-746-8231

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2013
Last Update Date	:	10/23/2013

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