Basic Information
| Provider Information | |||||||||
| NPI: | 1427284942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERALES | ||||||||
| FirstName: | YOLANDA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | LPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 806 ELM AVE | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939275676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316742180 | ||||||||
| FaxNumber: | 4084658281 | ||||||||
| Practice Location | |||||||||
| Address1: | 806 ELM AVE | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939275676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316742180 | ||||||||
| FaxNumber: | 4084658281 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2009 | ||||||||
| LastUpdateDate: | 06/10/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 167G00000X | PT26430 | CA | Y | Nursing Service Providers | Licensed Psychiatric Technician |
No ID Information.