Individual
RAPHAEL U PERALTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7210 40TH ST W STE 100, UNIVERSITY PLACE, WA 98466-4319
(253) 564-0170
Mailing address
7210 40TH ST W STE 100, UNIVERSITY PLACE, WA 98466-4319
(253) 564-0170
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
54221
MN
207Q00000X
Family Medicine Physician
Primary
MD60444232
WA
207Q00000X
Family Medicine Physician
RL10913
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0334185
STATE L&I
WA
05
—
2039224
—
WA
Enumeration date
07/07/2008
Last updated
12/08/2020
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