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NPI Code Detail

MEDICARE: PERRY MEDICAL GROUP OF CALIFORNIA

MEDICARE: PERRY MEDICAL GROUP OF CALIFORNIA
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
1208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1447970587
Entity Type Code : Organization
Provider Name (Legal Business Name) : PERRY MEDICAL GROUP OF CALIFORNIA
Provider Business Mailing Address
First Line : 169 MADISON AVE STE 90030
Second Line :
City : NEW YORK
State : NY
Zip : 10016-5101
Country : US
Telephone Number : 978-850-3914
Fax Number : 646-365-0517
Provider Business Practice Location Address
First Line : 16100 SAND CANYON AVE STE 240
Second Line :
City : IRVINE
State : CA
Zip : 92618-3724
Country : US
Telephone Number : 978-850-3914
Fax Number : 646-365-0517
Authorized Official
Title or Position : DIRECTOR, RCM
Name : JENNIFER HARLESS
Credential :
Telephone Number : 508-494-8275
Provider Enumeration Date : 08/30/2022
Last Update Date : 06/16/2026

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Directions to “PERRY MEDICAL GROUP OF CALIFORNIA ” Practice Location

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