Healthcare Provider Details

I. General information

NPI: 1487610499
Provider Name (Legal Business Name): FRANCISCO JOHN G PERALTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/14/2020
Certification Date: 05/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10835 NORTH 25TH AVENUE SUITE 115
PHOENIX AZ
85029-3452
US

IV. Provider business mailing address

10835 NORTH 25TH AVENUE SUITE 115
PHOENIX AZ
85029-3452
US

V. Phone/Fax

Practice location:
  • Phone: 602-789-0344
  • Fax: 602-789-8389
Mailing address:
  • Phone: 602-789-0344
  • Fax: 602-789-8389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number29843
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number29843
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: