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General NPI Number Information
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NPI Number | 1760089304
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Entity Type | Individual
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Provider Name | BUENAVENTURA PERALTA OTR/L
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Gender | Male
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Dates
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Enumeration Date | 10/07/2020
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 1950 S MOUNTAIN AVE
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City | ONTARIO
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State | CA
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Zip | 91762-6723
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Country | US
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Telephone | 909-983-0084
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Fax |
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Provider Business Mailing Address
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Address Line | 9200 MILLIKEN AVE APT 7114
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-8511
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Country | US
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Telephone | 909-528-2355
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 4236
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 26834
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License Number State | CA
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