MEDICARE: VINCENT PERINO

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	363A00000X	Physician Assistant	1144	AK

General Provider Information

NPI Number	:	1598189714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT PERINO

Provider Business Mailing Address
First Line	:	PO BOX 879352
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99687-9352
Country	:	US
Telephone Number	:	509-994-3692
Fax Number	:

Provider Business Practice Location Address
First Line	:	3190 E MERIDIAN PARK LOOP STE 207
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7422
Country	:	US
Telephone Number	:	907-631-4550
Fax Number	:	907-373-9461

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

Provider Enumeration Date	:	02/07/2014
Last Update Date	:	03/31/2021

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Directions to “ VINCENT PERINO ” Practice Location

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