Healthcare Provider Details

I. General information

NPI: 1922436245
Provider Name (Legal Business Name): VIRGINIA PERRY IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2013
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 STATE ST
SANTA BARBARA CA
93105-3134
US

IV. Provider business mailing address

PO BOX 1198
SACRAMENTO CA
95812-1198
US

V. Phone/Fax

Practice location:
  • Phone: 702-623-9133
  • Fax:
Mailing address:
  • Phone: 805-452-4962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number24324
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: