Healthcare Provider Details

I. General information

NPI: 1447970587
Provider Name (Legal Business Name): PERRY MEDICAL GROUP OF CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 SAND CANYON AVE STE 240
IRVINE CA
92618-3724
US

IV. Provider business mailing address

169 MADISON AVE STE 90030
NEW YORK NY
10016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 978-850-3914
  • Fax: 646-365-0517
Mailing address:
  • Phone: 978-850-3914
  • Fax: 646-365-0517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HARLESS
Title or Position: DIRECTOR, RCM
Credential:
Phone: 508-494-8275