Healthcare Provider Details

I. General information

NPI: 1346144797
Provider Name (Legal Business Name): EVAN PERRY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 WILSHIRE BLVD
LOS ANGELES CA
90010-3805
US

IV. Provider business mailing address

1297 W 36TH ST
LOS ANGELES CA
90007-3935
US

V. Phone/Fax

Practice location:
  • Phone: 323-836-0860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberB133B9A248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: