1417109828 NPI number — DR. LORI NAGISA SUNAMOTO PERRY M.D., M.P.H.

Table of content: DR. LORI NAGISA SUNAMOTO PERRY M.D., M.P.H. (NPI 1417109828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417109828 NPI number — DR. LORI NAGISA SUNAMOTO PERRY M.D., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRY
Provider First Name:
LORI
Provider Middle Name:
NAGISA SUNAMOTO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., M.P.H.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417109828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
H100 SANTA MARGARITA ROAD
Provider Second Line Business Mailing Address:
NAVAL HOSPITAL, CAMP PENDLETON, ATTN: CODE 094
Provider Business Mailing Address City Name:
CAMP PENDLETON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92055-5191
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-725-7137
Provider Business Mailing Address Fax Number:
760-725-6934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
H100 SANTA MARGARITA ROAD
Provider Second Line Business Practice Location Address:
NAVAL HOSPITAL, CAMP PENDLETON, ATTN: CODE 094
Provider Business Practice Location Address City Name:
CAMP PENDLETON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92055-5191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-725-7137
Provider Business Practice Location Address Fax Number:
760-725-6934
Provider Enumeration Date:
10/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083P0500X , with the licence number:  AFE96961 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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