Healthcare Provider Details

I. General information

NPI: 1023505781
Provider Name (Legal Business Name): MISS CAMILA PEGUERO PERALTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

286 FORT WASHINGTON AVE APT 1B
NEW YORK NY
10032-1316
US

IV. Provider business mailing address

51 BUCHANAN PL APT 6E
BRONX NY
10453-1443
US

V. Phone/Fax

Practice location:
  • Phone: 212-927-0300
  • Fax:
Mailing address:
  • Phone: 347-636-4045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: