Provider Demographics
NPI:1104921337
Name:PERALTA, ERLINDA SANGUYO (RD, CDE)
Entity type:Individual
Prefix:
First Name:ERLINDA
Middle Name:SANGUYO
Last Name:PERALTA
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86-080 FARRINGTON HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-3069
Mailing Address - Country:US
Mailing Address - Phone:808-696-0216
Mailing Address - Fax:808-696-0345
Practice Address - Street 1:86-080 FARRINGTON HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3069
Practice Address - Country:US
Practice Address - Phone:808-696-0216
Practice Address - Fax:808-696-0345
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI876863133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
54117Medicare PIN
P47340Medicare UPIN