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NPI Code Detail

MEDICARE: DANIELA PERALTA VAZQUEZ PSYD

MEDICARE: DANIELA PERALTA VAZQUEZ PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSB94027153CA

General Provider Information

NPI Number : 1457922742
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELA PERALTA VAZQUEZ PSYD
Provider Business Mailing Address
First Line : PO BOX 3420
Second Line :
City : SAN DIEGO
State : CA
Zip : 92163-1420
Country : US
Telephone Number : 619-363-2068
Fax Number :
Provider Business Practice Location Address
First Line : 1010 TURQUOISE ST STE 303
Second Line :
City : SAN DIEGO
State : CA
Zip : 92109-1268
Country : US
Telephone Number : 858-255-4095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2021
Last Update Date : 08/29/2024

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