Provider Demographics
NPI:1871911552
Name:PERILLA, ADRIANA SOFIA (MD)
Entity type:Individual
Prefix:
First Name:ADRIANA SOFIA
Middle Name:
Last Name:PERILLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 WILLET ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3837
Mailing Address - Country:US
Mailing Address - Phone:951-852-4104
Mailing Address - Fax:952-209-6735
Practice Address - Street 1:533 WILLET ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3837
Practice Address - Country:US
Practice Address - Phone:951-852-4104
Practice Address - Fax:952-209-6735
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18719115522084N0400X
CAA1528222084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology