Healthcare Provider Details

I. General information

NPI: 1093932840
Provider Name (Legal Business Name): JESSICA CATHERINE PERALTA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 09/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 7TH AVENUE #6
SAN FRANCISCO CA
94123-2373
US

IV. Provider business mailing address

215 7TH AVENUE #6
SAN FRANCISCO CA
94123-2373
US

V. Phone/Fax

Practice location:
  • Phone: 415-264-8200
  • Fax:
Mailing address:
  • Phone: 415-264-8200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number662389
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number11179801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: