Healthcare Provider Details

I. General information

NPI: 1457005704
Provider Name (Legal Business Name): ELLA CATHERINE PERRIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38400 BOB WILSON DR
SAN DIEGO CA
92134-5000
US

IV. Provider business mailing address

38400 BOB WILSON DR
SAN DIEGO CA
92134-5000
US

V. Phone/Fax

Practice location:
  • Phone: 919-455-7339
  • Fax:
Mailing address:
  • Phone: 919-455-7339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101279385
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: