Provider Demographics
NPI:1205545597
Name:PEREIRA, TRISTAN (PT, DPT)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4489 LEATHERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-0913
Mailing Address - Country:US
Mailing Address - Phone:805-444-9872
Mailing Address - Fax:
Practice Address - Street 1:1160 N VENTURA RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3802
Practice Address - Country:US
Practice Address - Phone:805-604-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist