Healthcare Provider Details

I. General information

NPI: 1932376274
Provider Name (Legal Business Name): RAYMOND PERRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BROXTON AVE 3RD FLOOR
LOS ANGELES CA
90024-2801
US

IV. Provider business mailing address

911 BROXTON AVE 3RD FLOOR
LOS ANGELES CA
90024-2801
US

V. Phone/Fax

Practice location:
  • Phone: 310-794-2904
  • Fax: 310-794-3288
Mailing address:
  • Phone: 310-794-2904
  • Fax: 310-794-3288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125050815
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA107565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: