Provider Demographics
NPI:1194268409
Name:PERALTA, NATALIA
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:PERALTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19800 SW 180TH AVE
Mailing Address - Street 2:LOT 135
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-2619
Mailing Address - Country:US
Mailing Address - Phone:786-521-8007
Mailing Address - Fax:
Practice Address - Street 1:19800 SW 180TH AVE
Practice Address - Street 2:LOT 135
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-2619
Practice Address - Country:US
Practice Address - Phone:786-521-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15623224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant