MEDICARE: ELIZABETH A PERALTA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	G83732	CA
2	2086X0206X	Surgical Oncology Physician	036102822	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215918784
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH A PERALTA M.D.

Provider Business Mailing Address
First Line	:	3883 AIRWAY DRIVE
Second Line	:	SUITE 201
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1671
Country	:	US
Telephone Number	:	707-521-8900
Fax Number	:	707-523-1309

Provider Business Practice Location Address
First Line	:	3883 AIRWAY DR STE 320
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-1671
Country	:	US
Telephone Number	:	707-541-7900
Fax Number	:	707-573-5431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	10/21/2025

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