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NPI Code Detail

MEDICARE: MRS. REGINA C PERDOMO

MEDICARE: MRS. REGINA C PERDOMO
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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1477670651
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. REGINA C PERDOMO
Provider Business Mailing Address
First Line : 325 W TUOLUMNE RD
Second Line :
City : TURLOCK
State : CA
Zip : 95382-1626
Country : US
Telephone Number : 209-668-2822
Fax Number :
Provider Business Practice Location Address
First Line : 421 E MORRIS AVE
Second Line :
City : MODESTO
State : CA
Zip : 95354-0437
Country : US
Telephone Number : 209-558-7494
Fax Number : 209-558-8918
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. REGINA C PERDOMO ” Practice Location

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