=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871911552
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIANA SOFIA PERILLA M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2014
-----------------------------------------------------
Last Update Date | 03/09/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 533 WILLET ST
-----------------------------------------------------
City | EL CAJON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92020-3837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-852-4104
-----------------------------------------------------
Fax | 952-209-6735
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 533 WILLET ST
-----------------------------------------------------
City | EL CAJON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92020-3837
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-852-4104
-----------------------------------------------------
Fax | 952-209-6735
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | 1871911552
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | A152822
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------