Provider Demographics
NPI:1093932840
Name:PERALTA, JESSICA CATHERINE (RN)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:CATHERINE
Last Name:PERALTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 7TH AVENUE
Mailing Address - Street 2:#6
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2373
Mailing Address - Country:US
Mailing Address - Phone:415-264-8200
Mailing Address - Fax:
Practice Address - Street 1:215 7TH AVENUE
Practice Address - Street 2:#6
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-2373
Practice Address - Country:US
Practice Address - Phone:415-264-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA662389163W00000X
CA11179801163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant