Healthcare Provider Details

I. General information

NPI: 1174454334
Provider Name (Legal Business Name): MARIA PERALTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 E SOUTH ST STE 203
LAKEWOOD CA
90805-4589
US

IV. Provider business mailing address

3300 E SOUTH ST STE 203
LAKEWOOD CA
90805-4589
US

V. Phone/Fax

Practice location:
  • Phone: 562-512-3320
  • Fax: 562-381-7764
Mailing address:
  • Phone: 562-512-3320
  • Fax: 562-381-7764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number53566
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: