Individual provider · Type 1 NPI
Mark Raymond Perreault, PA-C
Surgical Physician Assistant · San Diego, CA
NPI number
1356749451
Active
Practice location
200 W Arbor Dr
San Diego, CA 92103-9000
Mailing address
PO Box 232410
San Diego, CA 92193-2410
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physician Assistant | 363A00000X | 003332 (CT) |
| Medical Physician Assistant | 363AM0700X | 003332 (CT) |
| Surgical Physician Assistant Primary | 363AS0400X | PA57736 (CA) |
| Surgical Physician Assistant | 363AS0400X | 003332 (CT) |
Surgical Physician Assistant: Definition to come...
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About NPI 1356749451
Mark Raymond Perreault, PA-C's National Provider Identifier is 1356749451, issued on Dec 5, 2014. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in San Diego, CA. The record was last updated on Jul 20, 2021.