Provider Demographics
NPI:1285754796
Name:PEREIRA, LEON (PHD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4835
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-8835
Mailing Address - Country:US
Mailing Address - Phone:808-255-3618
Mailing Address - Fax:
Practice Address - Street 1:45-955 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 401
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3222
Practice Address - Country:US
Practice Address - Phone:808-255-3618
Practice Address - Fax:808-235-0321
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY 614103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51566Medicare PIN
HI576227Medicare UPIN