Healthcare Provider Details

I. General information

NPI: 1609425776
Provider Name (Legal Business Name): CHRISTA PERRYMAN AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 VETERANS BLVD
REDWOOD CITY CA
94063-2037
US

IV. Provider business mailing address

2368 SAN MARCO CT
MANTECA CA
95337-8231
US

V. Phone/Fax

Practice location:
  • Phone: 650-299-7687
  • Fax:
Mailing address:
  • Phone: 254-681-5941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number4764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: