Healthcare Provider Details

I. General information

NPI: 1013299593
Provider Name (Legal Business Name): NIKKA PERALTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2011
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 SAN PEDRO DR NE BLDG B1
ALBUQUERQUE NM
87110-8903
US

IV. Provider business mailing address

1305 SAN LORENZO AVE NW
ALBUQUERQUE NM
87107-3427
US

V. Phone/Fax

Practice location:
  • Phone: 505-903-5437
  • Fax: 505-344-2104
Mailing address:
  • Phone: 505-903-5437
  • Fax: 505-344-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-09284
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: