Individual
AARONJACK RUSSELL PERRY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1545 5TH ST, CLOVIS, CA 93611-1411
(559) 281-9575
Mailing address
1545 5TH ST, CLOVIS, CA 93611-1411
(559) 281-9575
Taxonomy
Speciality
Code
Description
License number
State
374K00000X
Religious Nonmedical Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83109
CALIFORNIA COMMUNITY NETWORK
—
Enumeration date
02/27/2018
Last updated
02/27/2018
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