Provider Demographics
NPI:1427334507
Name:PERALES, TINA LOUISE
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LOUISE
Last Name:PERALES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:LOUISE
Other - Last Name:RUBIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:17800 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-7079
Mailing Address - Country:US
Mailing Address - Phone:562-866-8956
Mailing Address - Fax:
Practice Address - Street 1:17800 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-7079
Practice Address - Country:US
Practice Address - Phone:562-866-8956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical