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General NPI Number Information
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NPI Number | 1629669429
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Entity Type | Individual
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Provider Name | RYAN PERRY MBA, MMS, PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 01/23/2022
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Provider Practice Location Address
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Address Line | 2615 E CLINTON AVE
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City | FRESNO
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State | CA
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Zip | 93703-2223
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Country | US
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Telephone | 559-225-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 10753 E ESTRO BAY
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City | CLOVIS
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State | CA
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Zip | 93619-4726
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Country | US
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Telephone | 760-535-2304
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA59118
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License Number State | CA
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