Basic Information
| Provider Information | |||||||||
| NPI: | 1740530518 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIERRE-LOUIS | ||||||||
| FirstName: | KERBY | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 828 W VENTURA ST | ||||||||
| Address2: | |||||||||
| City: | FILLMORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930151876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055242000 | ||||||||
| FaxNumber: | 8055249601 | ||||||||
| Practice Location | |||||||||
| Address1: | 2323 KNOLL DR | ||||||||
| Address2: | SUITE 219 | ||||||||
| City: | VENTURA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930037307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056775181 | ||||||||
| FaxNumber: | 8056775304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2012 | ||||||||
| LastUpdateDate: | 04/28/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA22357 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 015836 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.