Healthcare Provider Details

I. General information

NPI: 1225687213
Provider Name (Legal Business Name): CARIANN LYNN PERUMAL
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2019
Last Update Date: 09/14/2024
Certification Date: 09/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PARNASSUS AVE # 244
SAN FRANCISCO CA
94143-2203
US

IV. Provider business mailing address

500 PARNASSUS AVE # 244
SAN FRANCISCO CA
94143-2203
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-8280
  • Fax:
Mailing address:
  • Phone: 415-476-8280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: