John Perdomo, PSYCHOLOGIST
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Ione, CA
NPI 1245985142 · NPPES record last updated Feb 18, 2022
Key facts
- NPI
- 1245985142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 4001 Ca 104 Hwy
Ione, CA 95640 - Phone
- (209) 274-4911
- NPI assigned
- Feb 18, 2022
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
4001 Ca 104 Hwy
Ione, CA 95640
Mailing address
12736 Cordyline Way
Rancho Cordova, CA 95742-6726
Phone (626) 922-3518
Other providers in Ione, CA
- Jessica Anne Baxter Nelson
- Khari Nelson
- Cheryl Oneto
- Yoselin Elizabeth Ortiz-Luna
- Holly Diane Parks
- Tyler Peterson
- Alfiea Porter
- Preston Youth Correctional Facility
- Marina Protsenko
- Naliyah Palacios Renegado
All providers in Ione, CA · Student in an Organized Health Care Education/Training Program in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.