Basic Information
| Provider Information | |||||||||
| NPI: | 1184165300 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERDUE | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | COLEMAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 447 N EL MOLINO AVE | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911011403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265778480 | ||||||||
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| Practice Location | |||||||||
| Address1: | 43807 10TH ST W STE D | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935344805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6615759365 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2017 | ||||||||
| LastUpdateDate: | 09/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 376K00000X | 00365636 | CA | N | Nursing Service Related Providers | Nurse's Aide | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.