Provider Demographics
NPI:1578188785
Name:PERAL, DANA LAURA M
Entity Type:Individual
Prefix:
First Name:DANA LAURA
Middle Name:M
Last Name:PERAL
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 1:13107 5TH ST
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-3668
Mailing Address - Country:US
Mailing Address - Phone:240-640-2103
Mailing Address - Fax:
Practice Address - Street 1:13107 5TH ST
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-3668
Practice Address - Country:US
Practice Address - Phone:240-640-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician