Provider Demographics
NPI:1346086733
Name:PERALTA, DEBORAH RENEE
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:RENEE
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 1:5123 NE 94TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6181
Mailing Address - Country:US
Mailing Address - Phone:801-631-0352
Mailing Address - Fax:
Practice Address - Street 1:5123 NE 94TH AVE STE A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6181
Practice Address - Country:US
Practice Address - Phone:801-631-0352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist