Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision | 4105 | MA |
NPI | 1114118734 |
---|---|
Provider Name | Ms. Denise Chrystine Peralta |
First Address | Worcester, MA 01606-3071 |
Second Address | Worcester, MA 01606-3071 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2007 |
Last Update Date | 24/03/2014 |