Healthcare Provider Details

I. General information

NPI: 1508703240
Provider Name (Legal Business Name): JESUS PERALTA MARTINEZ APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7743 W 34TH CT
HIALEAH FL
33018-5008
US

IV. Provider business mailing address

7743 W 34TH CT
HIALEAH FL
33018-5008
US

V. Phone/Fax

Practice location:
  • Phone: 502-345-3895
  • Fax:
Mailing address:
  • Phone: 502-345-3895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11046869
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: