Provider Demographics
NPI:1427415413
Name:PERALTA, ESMERALDA
Entity Type:Individual
Prefix:
First Name:ESMERALDA
Middle Name:
Last Name:PERALTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21520 PIONEER BLVD STE 110
Mailing Address - Street 2:
Mailing Address - City:HAWAIIAN GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90716-2604
Mailing Address - Country:US
Mailing Address - Phone:562-865-3644
Mailing Address - Fax:562-246-5702
Practice Address - Street 1:21520 PIONEER BLVD STE 110
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-2604
Practice Address - Country:US
Practice Address - Phone:562-865-3644
Practice Address - Fax:562-246-5702
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA796131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical