Provider Demographics
NPI:1487770343
Name:PERERA, LOUIS
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:PERERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10801 LOMAS BLVD NE
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-5401
Mailing Address - Country:US
Mailing Address - Phone:505-238-6680
Mailing Address - Fax:
Practice Address - Street 1:10801 LOMAS BLVD NE
Practice Address - Street 2:SUITE 115
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-5401
Practice Address - Country:US
Practice Address - Phone:505-238-6680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator