Healthcare Provider Details

I. General information

NPI: 1306188131
Provider Name (Legal Business Name): GLEN ERIC PERLMAN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-0002
US

IV. Provider business mailing address

5040 KEENEY ST APT 39
LA MESA CA
91942-7459
US

V. Phone/Fax

Practice location:
  • Phone: 760-613-9855
  • Fax:
Mailing address:
  • Phone: 760-613-9855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number562060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: