Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | G65464 | CA |
N | 208600000X | Surgeon | G65464 | CA |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | G65464 | CA |
NPI | 1104842129 |
---|---|
Provider Name | Dr. Anthony Perricone |
First Address | San Diego, CA 92103-9001 |
Second Address | San Diego, CA 92103-9001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 06/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G654640 | (05) | CA |
F32917 | (02) | CA |