MEDICARE: MONICA PERLMAN MD INC.

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	207Q00000X	Family Medicine Physician	544547	CA
2	207R00000X	Internal Medicine Physician	544547	CA
3	261QU0200X	Urgent Care Clinic/Center	544547	CA
4	261QP2300X	Primary Care Clinic/Center	G70356	CA

General Provider Information

NPI Number	:	1215458153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONICA PERLMAN MD INC.

Provider Business Mailing Address
First Line	:	9850 GENESEE AVE
Second Line	:	SUITE 320
City	:	LA JOLLA
State	:	CA
Zip	:	92037-1208
Country	:	US
Telephone Number	:	858-554-1212
Fax Number	:	858-554-1222

Provider Business Practice Location Address
First Line	:	4142 ADAMS AVE STE 102
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-2593
Country	:	US
Telephone Number	:	858-617-0717
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MITCHELL PERLMAN
Credential	:
Telephone Number	:	858-554-1212

Provider Enumeration Date	:	06/30/2017
Last Update Date	:	09/30/2019

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