Doctor Name: | PHILIPPINE DANA DAWN PERALTA |
NPI Number: | 1962842419 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | 01075212A |
Business Practice Address: | 3551 Roger Brooke Drive San Antonio Military Med Center, Dept Of Med, Mche-mdx Fort Sam Houston, TX - 782346200 |
Business Phone Number: | 2102925077 |
Business Fax Number: | 2109164721 |
Mailing Address: | 3551 Roger Brooke Drive,, San Antonio Military Med Center, Dept Of Med, Mche-mdx FORT SAM HOUSTON |
State: | TX |
Postal Code: | 782346200 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 06/28/2013 |
NPI Last Update Date: | 03/10/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 01075212A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |