Provider Demographics
NPI:1538728795
Name:PERRY, MARY BETH
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:PERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:ZAVICAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UCLA ANESTHESIOLOGY 757 WESTWOOD PLAZA SUITE 3325
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7403
Mailing Address - Country:US
Mailing Address - Phone:310-267-3890
Mailing Address - Fax:
Practice Address - Street 1:2338 STATE AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4361
Practice Address - Country:US
Practice Address - Phone:850-872-0303
Practice Address - Fax:850-872-0305
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007095367500000X
CARN95179984367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty