Healthcare Provider Details

I. General information

NPI: 1215918784
Provider Name (Legal Business Name): ELIZABETH A PERALTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3883 AIRWAY DR STE 320
SANTA ROSA CA
95403-1671
US

IV. Provider business mailing address

3883 AIRWAY DRIVE SUITE 201
SANTA ROSA CA
95403-1671
US

V. Phone/Fax

Practice location:
  • Phone: 707-541-7900
  • Fax: 707-573-5431
Mailing address:
  • Phone: 707-521-8900
  • Fax: 707-523-1309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG83732
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number036102822
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: