Provider Demographics
NPI:1164737680
Name:PERALES, RONALD W (LMFT #96997)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:W
Last Name:PERALES
Suffix:
Gender:M
Credentials:LMFT #96997
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2718 DALEMEAD ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-7013
Mailing Address - Country:US
Mailing Address - Phone:424-625-4531
Mailing Address - Fax:310-634-1857
Practice Address - Street 1:2211 PALO VERDE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-2360
Practice Address - Country:US
Practice Address - Phone:424-230-1349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT #96997106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000000000OtherMEDI CAL