Healthcare Provider Details

I. General information

NPI: 1902925795
Provider Name (Legal Business Name): VICTOR H PERALTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

941 E PARK ROW DR
ARLINGTON TX
76010-4508
US

IV. Provider business mailing address

222 W. LAS COLINAS BLVD SUITE 2000
IRVING TX
75039
US

V. Phone/Fax

Practice location:
  • Phone: 817-522-0221
  • Fax: 817-522-0401
Mailing address:
  • Phone: 972-957-3000
  • Fax: 972-236-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF0114
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: