Provider Demographics
NPI:1073789574
Name:NOVOA DE PERALES, MILAGROS DANET
Entity Type:Individual
Prefix:MS
First Name:MILAGROS
Middle Name:DANET
Last Name:NOVOA DE PERALES
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MILAGROS
Other - Middle Name:DANET
Other - Last Name:PERALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:413 E POST RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-9043
Mailing Address - Country:US
Mailing Address - Phone:479-636-3202
Mailing Address - Fax:
Practice Address - Street 1:413 E POST RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-9043
Practice Address - Country:US
Practice Address - Phone:479-636-3202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0775912001171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155138783Medicaid