Healthcare Provider Details

I. General information

NPI: 1326969387
Provider Name (Legal Business Name): REGINA MARIA PERALTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

686 HUMBOLDT ST
RICHMOND CA
94805-1959
US

IV. Provider business mailing address

160 BRANNAN ST APT 201
SAN FRANCISCO CA
94107-2074
US

V. Phone/Fax

Practice location:
  • Phone: 510-236-3388
  • Fax:
Mailing address:
  • Phone: 510-236-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number458131
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: