Healthcare Provider Details

I. General information

NPI: 1649212846
Provider Name (Legal Business Name): JANESSA I PERALTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 COURT ST
REDDING CA
96001-1721
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 530-247-8800
  • Fax: 530-241-1174
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA110592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: