Healthcare Provider Details

I. General information

NPI: 1083796007
Provider Name (Legal Business Name): THEION WILLIAMS PERKINS IV R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: THEION WILLIAMS PERKINS R.N.

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

IV. Provider business mailing address

550 S VERMONT AVE
LOS ANGELES CA
90020-1912
US

V. Phone/Fax

Practice location:
  • Phone: 213-351-5494
  • Fax: 213-427-6161
Mailing address:
  • Phone: 213-351-5494
  • Fax: 213-427-6161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number445154
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: