Healthcare Provider Details

I. General information

NPI: 1124856166
Provider Name (Legal Business Name): ANA MARIA CAMPO PERALTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date: 06/12/2026
Reactivation Date: 07/21/2026

III. Provider practice location address

2919 MISSION ST
SAN FRANCISCO CA
94110-3917
US

IV. Provider business mailing address

2919 MISSION ST
SAN FRANCISCO CA
94110-3917
US

V. Phone/Fax

Practice location:
  • Phone: 415-229-0500
  • Fax:
Mailing address:
  • Phone: 415-229-0500
  • Fax: 510-412-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: