Individual
MR. MARK RAYMOND PERREAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
200 W ARBOR DR, SAN DIEGO, CA 92103-9000
(800) 926-8273
Mailing address
PO BOX 232410, SAN DIEGO, CA 92193-2410
(800) 926-8273
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
003332
CT
363AM0700X
Medical Physician Assistant
003332
CT
363AS0400X
Surgical Physician Assistant
003332
CT
363AS0400X
Surgical Physician Assistant
Primary
PA57736
CA
Other
Enumeration date
12/05/2014
Last updated
07/20/2021
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