Healthcare Provider Details

I. General information

NPI: 1427415413
Provider Name (Legal Business Name): ESMERALDA PERALTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21520 PIONEER BLVD STE 110
HAWAIIAN GARDENS CA
90716-2604
US

IV. Provider business mailing address

21520 PIONEER BLVD STE 110
HAWAIIAN GARDENS CA
90716-2604
US

V. Phone/Fax

Practice location:
  • Phone: 562-865-3644
  • Fax: 562-246-5702
Mailing address:
  • Phone: 562-865-3644
  • Fax: 562-246-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number79613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: