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General NPI Number Information
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NPI Number | 1932619509
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Entity Type | Individual
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Provider Name | JESSE PERKINS PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/09/2017
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Last Update Date | 12/14/2024
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Provider Practice Location Address
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Address Line | 74320 HIGHWAY 111
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City | PALM DESERT
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State | CA
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Zip | 92260-4140
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Country | US
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Telephone | 760-423-5610
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Fax | 760-601-3448
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Provider Business Mailing Address
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Address Line | 2409 ARTESIA BLVD FL 2
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City | REDONDO BEACH
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State | CA
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Zip | 90278-3207
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 13084735-1206
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 55149
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License Number State | CA
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