Provider Demographics
NPI:1912412743
Name:PERALTA, INDIRA (RN)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:
Last Name:PERALTA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:549 ISHAM ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2122
Mailing Address - Country:US
Mailing Address - Phone:646-488-3084
Mailing Address - Fax:
Practice Address - Street 1:6355 BROADWAY
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-2701
Practice Address - Country:US
Practice Address - Phone:347-933-7780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY698657163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse