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General NPI Number Information
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NPI Number | 1073973053
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Entity Type | Individual
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Provider Name | KAMLEY PERALTE
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Gender | Male
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Dates
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Enumeration Date | 03/03/2016
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Last Update Date | 03/03/2016
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Provider Practice Location Address
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Address Line | 6421 VIRGILIA CT
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City | RALEIGH
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State | NC
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Zip | 27616-3170
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Country | US
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Telephone | 646-382-3053
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Fax |
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Provider Business Mailing Address
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Address Line | 6421 VIRGILIA CT
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City | RALEIGH
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State | NC
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Zip | 27616-3170
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | A5622
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License Number State | NC
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