Provider Demographics
NPI:1154423218
Name:PERALTA, ANGELICA M (ASSIST SPL)
Entity type:Individual
Prefix:MRS
First Name:ANGELICA
Middle Name:M
Last Name:PERALTA
Suffix:
Gender:F
Credentials:ASSIST SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5419
Mailing Address - Country:US
Mailing Address - Phone:956-381-1515
Mailing Address - Fax:
Practice Address - Street 1:1900 W SCHUNIOR ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-2233
Practice Address - Country:US
Practice Address - Phone:956-984-6000
Practice Address - Fax:956-984-6169
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX334972355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant