Provider Demographics
NPI:1053502112
Name:PERAL, GISLENE MARIA
Entity Type:Individual
Prefix:
First Name:GISLENE
Middle Name:MARIA
Last Name:PERAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 OLEMA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:CA
Mailing Address - Zip Code:94930-1318
Mailing Address - Country:US
Mailing Address - Phone:415-460-5159
Mailing Address - Fax:
Practice Address - Street 1:336 OLEMA RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:CA
Practice Address - Zip Code:94930-1318
Practice Address - Country:US
Practice Address - Phone:415-460-5159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 2005225X00000X
CA2005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist