Provider Demographics
NPI:1295716629
Name:PERALEZ, MARISELDA (NP, PA-C)
Entity type:Individual
Prefix:
First Name:MARISELDA
Middle Name:
Last Name:PERALEZ
Suffix:
Gender:F
Credentials:NP, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 CORRAL DE TIERRA RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93908-8917
Mailing Address - Country:US
Mailing Address - Phone:831-578-8140
Mailing Address - Fax:
Practice Address - Street 1:387 CORRAL DE TIERRA RD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93908-8917
Practice Address - Country:US
Practice Address - Phone:831-578-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 16840363A00000X
CARN 547915 NP 14011363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 16840Medicaid
CARN 547915Medicaid
OPA 168400Medicare ID - Type UnspecifiedAS A PA
P 87098Medicare UPIN