Provider Demographics
NPI:1952029886
Name:PERALTA, JOSEPHINE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:
Last Name:PERALTA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:JOSEPHINE
Other - Middle Name:
Other - Last Name:VALDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:810 LAWRENCE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-6615
Mailing Address - Country:US
Mailing Address - Phone:805-667-8200
Mailing Address - Fax:
Practice Address - Street 1:810 LAWRENCE DR STE 100
Practice Address - Street 2:
Practice Address - City:NEWBURY PARK
Practice Address - State:CA
Practice Address - Zip Code:91320-6615
Practice Address - Country:US
Practice Address - Phone:805-667-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist