Provider Demographics
NPI:1649212846
Name:PERALTA, JANESSA I (MD)
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:I
Last Name:PERALTA
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 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1755 COURT ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1721
Practice Address - Country:US
Practice Address - Phone:530-247-8800
Practice Address - Fax:530-241-1174
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110592208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30206045Medicaid
4149148OtherMVP
AA62493OtherHARVARD PILGRIM HEALTH
732288OtherCIGNA
01YP10636NH01OtherANTHEM
1290921OtherAETNA
NHI58830Medicare UPIN
NH30206045Medicaid