Provider Demographics
NPI:1609602424
Name:PERRY, DESMOND DUVAL
Entity type:Individual
Prefix:
First Name:DESMOND
Middle Name:DUVAL
Last Name:PERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8750 MELLMANOR DR APT 54
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3165
Mailing Address - Country:US
Mailing Address - Phone:619-581-2812
Mailing Address - Fax:
Practice Address - Street 1:8750 MELLMANOR DR APT 54
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3165
Practice Address - Country:US
Practice Address - Phone:619-581-2812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver