Provider Demographics
NPI:1427284942
Name:PERALES, YOLANDA A (LPT)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:A
Last Name:PERALES
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93927-5676
Mailing Address - Country:US
Mailing Address - Phone:831-674-2180
Mailing Address - Fax:408-465-8281
Practice Address - Street 1:806 ELM AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:CA
Practice Address - Zip Code:93927-5676
Practice Address - Country:US
Practice Address - Phone:831-674-2180
Practice Address - Fax:408-465-8281
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26430167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician