Healthcare Provider Details

I. General information

NPI: 1962918912
Provider Name (Legal Business Name): MONICA PERLMAN MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7855 IVANHOE AVE STE 110
LA JOLLA CA
92037-4507
US

IV. Provider business mailing address

9850 GENESEE AVE STE 320
LA JOLLA CA
92037-1208
US

V. Phone/Fax

Practice location:
  • Phone: 858-869-0188
  • Fax:
Mailing address:
  • Phone: 858-554-1212
  • Fax: 858-554-1222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number544547
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number544547
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number544547
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number544547
License Number StateCA

VIII. Authorized Official

Name: MITCHELL PERLMAN
Title or Position: CEO
Credential:
Phone: 858-554-1212