Healthcare Provider Details

I. General information

NPI: 1649104811
Provider Name (Legal Business Name): LAURA PERALES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDONDO AVE STE 500
LONG BEACH CA
90806-2330
US

IV. Provider business mailing address

2600 REDONDO AVE STE 500
LONG BEACH CA
90806-2330
US

V. Phone/Fax

Practice location:
  • Phone: 562-304-1740
  • Fax:
Mailing address:
  • Phone: 562-304-1740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number840644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: