Provider Demographics
NPI:1487762027
Name:PEREIRA, ALEXIS (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ST. LIRIO 3009 BUENAVENTURA
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00682-1271
Mailing Address - Country:US
Mailing Address - Phone:787-834-0491
Mailing Address - Fax:787-834-0491
Practice Address - Street 1:3009 CALLE LIRIO, BUENAVENTURA
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1271
Practice Address - Country:US
Practice Address - Phone:787-834-0491
Practice Address - Fax:787-834-0491
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16152208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0023834Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER