Provider Demographics
NPI:1104008598
Name:NICHOLAS PEREIRA MDPA
Entity type:Organization
Organization Name:NICHOLAS PEREIRA MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-451-2316
Mailing Address - Street 1:5111 N 10TH ST
Mailing Address - Street 2:# 112
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2835
Mailing Address - Country:US
Mailing Address - Phone:956-451-2316
Mailing Address - Fax:956-631-6717
Practice Address - Street 1:5111 N 10TH ST
Practice Address - Street 2:# 112
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2835
Practice Address - Country:US
Practice Address - Phone:956-451-2316
Practice Address - Fax:956-631-6717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3389208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190654701Medicaid