Provider Demographics
NPI:1336653823
Name:PERALTA, LUISA (PSY D)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:
Last Name:PERALTA
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4768 GRAPEVINE WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3364
Mailing Address - Country:US
Mailing Address - Phone:954-608-1739
Mailing Address - Fax:
Practice Address - Street 1:12955 BISCAYNE BLVD STE 306
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-2022
Practice Address - Country:US
Practice Address - Phone:954-465-1633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-20
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10044103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical