Healthcare Provider Details

I. General information

NPI: 1598172686
Provider Name (Legal Business Name): VIVIANA PERALES M.A. ED S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/04/2022
Certification Date: 07/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MONTGOMERY ST STE 1850
SAN FRANCISCO CA
94104-3531
US

IV. Provider business mailing address

PO BOX 1732
UPLAND CA
91785-1732
US

V. Phone/Fax

Practice location:
  • Phone: 951-977-1787
  • Fax:
Mailing address:
  • Phone: 951-977-1787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberD6301559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: