Provider Demographics
NPI:1578015350
Name:PERALTA, MARK CADIENTE (DPT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CADIENTE
Last Name:PERALTA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19755 ARBOR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-5315
Mailing Address - Country:US
Mailing Address - Phone:909-762-1298
Mailing Address - Fax:
Practice Address - Street 1:19755 ARBOR RIDGE DR
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-5315
Practice Address - Country:US
Practice Address - Phone:909-762-1298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382542251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics