Healthcare Provider Details

I. General information

NPI: 1114840733
Provider Name (Legal Business Name): ALEJANDRO JOSE PERALTA ORTEGA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13760 N 93RD AVE STE 101
PEORIA AZ
85381-4203
US

IV. Provider business mailing address

3260 N HAYDEN RD STE 112
SCOTTSDALE AZ
85251-6650
US

V. Phone/Fax

Practice location:
  • Phone: 623-547-2600
  • Fax: 623-547-1899
Mailing address:
  • Phone: 602-264-9100
  • Fax: 602-264-9101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number219074
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: