Provider Demographics
NPI:1427801315
Name:PERALTA, JOSHUA RAY
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:RAY
Last Name:PERALTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4704 JENNIFER DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1729
Mailing Address - Country:US
Mailing Address - Phone:505-697-9473
Mailing Address - Fax:
Practice Address - Street 1:4704 JENNIFER DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1729
Practice Address - Country:US
Practice Address - Phone:505-697-9473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical