Healthcare Provider Details

I. General information

NPI: 1952029886
Provider Name (Legal Business Name): JOSEPHINE ANNE PERALTA MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOSEPHINE VALDEZ

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD STE 700
LONG BEACH CA
90807-2000
US

IV. Provider business mailing address

810 LAWRENCE DR STE 100
NEWBURY PARK CA
91320-6615
US

V. Phone/Fax

Practice location:
  • Phone: 818-894-2273
  • Fax: 818-357-2505
Mailing address:
  • Phone: 805-667-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number31708
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: