Healthcare Provider Details

I. General information

NPI: 1902395502
Provider Name (Legal Business Name): HENRY LEWIS PERRY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 05/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 LINDEN AVE APT 30
LONG BEACH CA
90802-5031
US

IV. Provider business mailing address

65 LINDEN AVE APT 30
LONG BEACH CA
90802-5031
US

V. Phone/Fax

Practice location:
  • Phone: 562-310-3215
  • Fax: 562-612-0270
Mailing address:
  • Phone: 562-310-3215
  • Fax: 562-612-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number766291
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number766291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: