Provider Demographics
NPI:1417988056
Name:DEPERALTA, UMA A (MD)
Entity Type:Individual
Prefix:DR
First Name:UMA
Middle Name:A
Last Name:DEPERALTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5013
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91778-5013
Mailing Address - Country:US
Mailing Address - Phone:626-571-4590
Mailing Address - Fax:626-307-7369
Practice Address - Street 1:1840 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3930
Practice Address - Country:US
Practice Address - Phone:626-571-4590
Practice Address - Fax:626-307-7369
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2024-03-23
Deactivation Date:2019-11-22
Deactivation Code:
Reactivation Date:2020-09-16
Provider Licenses
StateLicense IDTaxonomies
CAA37343207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA37343AOtherMEDICARE
CAWA37343AOtherMEDICARE