Provider Demographics
NPI:1164105862
Name:PERALTA, LAUREN (BS)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:PERALTA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35435 SUMAC AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-2519
Mailing Address - Country:US
Mailing Address - Phone:951-219-1871
Mailing Address - Fax:
Practice Address - Street 1:35435 SUMAC AVE
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-2519
Practice Address - Country:US
Practice Address - Phone:951-219-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty