Healthcare Provider Details

I. General information

NPI: 1518946623
Provider Name (Legal Business Name): KARINE MONIQUE HOLLIS-PERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NAVAL MEDICAL CENTER
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

2157 ARNOLD WAY
ALPINE CA
91901-2166
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7937
  • Fax:
Mailing address:
  • Phone: 619-445-8753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License NumberA75380
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number69841
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: