Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G83732 | CA |
Y | 208600000X | Surgeon | G83732 | CA |
N | 2086X0206X | Surgical Oncologist | 036102822 | IL |
NPI | 1215918784 |
---|---|
Provider Name | Elizabeth A Peralta |
First Address | Santa Rosa, CA 95403-1671 |
Second Address | Santa Rosa, CA 95403-1671 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 06/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036102822 | (05) | IL |
G57016 | (02) |