Healthcare Provider Details

I. General information

NPI: 1790975969
Provider Name (Legal Business Name): KARLA MARGUERITE PERISHO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARLA MARGUERITE PARSONS FNP

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FALLS CANYON ROAD
AVALON CA
90704
US

IV. Provider business mailing address

100 FALLS CANYON ROAD P.O. BOX 1583
AVALON CA
90704
US

V. Phone/Fax

Practice location:
  • Phone: 310-510-0096
  • Fax: 310-510-2381
Mailing address:
  • Phone: 310-510-0096
  • Fax: 310-510-2381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number459718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: