Healthcare Provider Details

I. General information

NPI: 1699697375
Provider Name (Legal Business Name): EFIGENIO PERALTA PINERA AGPCNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44955 BOURNE TER
ASHBURN VA
20147-2763
US

IV. Provider business mailing address

44955 BOURNE TER
ASHBURN VA
20147-2763
US

V. Phone/Fax

Practice location:
  • Phone: 703-622-2864
  • Fax:
Mailing address:
  • Phone: 703-622-2864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0024198163
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number0024198163
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: