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1003454851

NPI Code Detail

MEDICARE: LARISSA PERRY

MEDICARE: LARISSA PERRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1003454851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARISSA PERRY

Provider Business Mailing Address
First Line	:	1811 GRAND CANAL BLVD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-8155
Country	:	US
Telephone Number	:	888-880-9270
Fax Number	:

Provider Business Practice Location Address
First Line	:	1811 GRAND CANAL BLVD
Second Line	:
City	:	STOCKTON
State	:	CA
Zip	:	95207-8155
Country	:	US
Telephone Number	:	888-880-9270
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2019
Last Update Date	:	02/27/2026

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Directions to “ LARISSA PERRY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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