Provider Demographics
NPI:1639053341
Name:PERALTA, JULISA (RDN)
Entity type:Individual
Prefix:
First Name:JULISA
Middle Name:
Last Name:PERALTA
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-1008
Mailing Address - Country:US
Mailing Address - Phone:973-653-1275
Mailing Address - Fax:973-653-1275
Practice Address - Street 1:267 VERNON AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-1008
Practice Address - Country:US
Practice Address - Phone:973-653-1275
Practice Address - Fax:973-653-1275
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ86329323133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered