Healthcare Provider Details

I. General information

NPI: 1023973567
Provider Name (Legal Business Name): JACOB ANTONIO PERALTA RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E 14TH ST
HASTINGS NE
68901-3200
US

IV. Provider business mailing address

223 E 14TH ST
HASTINGS NE
68901-3200
US

V. Phone/Fax

Practice location:
  • Phone: 402-460-0367
  • Fax: 402-882-9100
Mailing address:
  • Phone: 402-460-0367
  • Fax: 402-882-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: