Provider Demographics
NPI:1922311182
Name:PERALES, KIMBERLY LIOTTA (DC)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LIOTTA
Last Name:PERALES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:LIOTTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:500 BOLLINGER CANYON WAY STE A15
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5297
Mailing Address - Country:US
Mailing Address - Phone:925-735-8508
Mailing Address - Fax:844-272-5913
Practice Address - Street 1:500 BOLLINGER CANYON WAY STE A15
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94582-5297
Practice Address - Country:US
Practice Address - Phone:925-735-8508
Practice Address - Fax:844-272-5913
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31559111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFX903AMedicare PIN