Healthcare Provider Details

I. General information

NPI: 1720211972
Provider Name (Legal Business Name): RANDALL CHRISTOPHER PERKINS CTRS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 04/23/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 MOTOR AVE REHABILITATION DEPARTMENT
LOS ANGELES CA
90034-3710
US

IV. Provider business mailing address

3200 MOTOR AVE
LOS ANGELES CA
90034-3740
US

V. Phone/Fax

Practice location:
  • Phone: 310-836-1223
  • Fax:
Mailing address:
  • Phone: 310-621-5497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: