Provider Demographics
NPI:1598494478
Name:PERALTA, JENNETTE DENISE (RD/LD/N)
Entity Type:Individual
Prefix:MRS
First Name:JENNETTE
Middle Name:DENISE
Last Name:PERALTA
Suffix:
Gender:F
Credentials:RD/LD/N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 SW 150TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5620
Mailing Address - Country:US
Mailing Address - Phone:305-502-5442
Mailing Address - Fax:
Practice Address - Street 1:2640 SW 150TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5620
Practice Address - Country:US
Practice Address - Phone:305-502-5442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4561133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered