Provider Demographics
NPI:1144613282
Name:PERALTA, RACHEL (MS, LCGC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:PERALTA
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9449 IMPERIAL HWY
Mailing Address - Street 2:STE 432
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2814
Mailing Address - Country:US
Mailing Address - Phone:562-657-4842
Mailing Address - Fax:
Practice Address - Street 1:1188 N EUCLID ST RM 220
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1900
Practice Address - Country:US
Practice Address - Phone:714-254-2704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGC000643OtherCALIFORNIA DEPT. OF HEALTH GENETIC COUNSELING LICENSE