Nathan Shawn Peralta Thephavongsa
NPI #1912630450 in Represa, California
Provider Information
- NPI Number
- 1912630450
- Entity Type
- Individual
- Name
- Nathan Shawn Peralta Thephavongsa
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Marriage & Family Therapist
- Enumeration Date
- Jul 1, 2022
- Last Updated
- Feb 21, 2025
Practice Location
- Address
- 100 FOLSOM PRISON RD
- City
- Represa
- State
- California
- ZIP Code
- 95671-6245
- Phone
- (916) 985-8610
Specialties & Taxonomy Codes
| Specialty |
|---|
| Marriage & Family Therapist |
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