Provider Demographics
NPI:1518703776
Name:JAVIER PERALES
Entity type:Organization
Organization Name:JAVIER PERALES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:PERALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-357-4037
Mailing Address - Street 1:PO BOX 1543
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781-1543
Mailing Address - Country:US
Mailing Address - Phone:657-357-4037
Mailing Address - Fax:
Practice Address - Street 1:218 W MAIN ST STE 202C
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7710
Practice Address - Country:US
Practice Address - Phone:657-357-4037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-06
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health