Provider Demographics
NPI:1992680862
Name:PERALTA, FABIAN EMILIO
Entity type:Individual
Prefix:
First Name:FABIAN
Middle Name:EMILIO
Last Name:PERALTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 N 102ND ST
Mailing Address - Street 2:301 S 70TH ST, STE 360
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68527-9708
Mailing Address - Country:US
Mailing Address - Phone:402-870-8255
Mailing Address - Fax:
Practice Address - Street 1:301 S 70TH ST STE 360
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2469
Practice Address - Country:US
Practice Address - Phone:414-202-9475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider