Provider Demographics
NPI:1316941925
Name:PEREIRA, NICHOLAS (MD PA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:956-631-9739
Mailing Address - Fax:956-631-6717
Practice Address - Street 1:1102 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9105
Practice Address - Country:US
Practice Address - Phone:956-388-6000
Practice Address - Fax:956-289-2956
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3389208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0029XROtherBC/BS
TX190654701Medicaid
TXG56936Medicare UPIN
TX044721105Medicaid
TX190654701Medicaid
TX136228101OtherVALLEY HEALTH PLANS