Provider Demographics
NPI:1992884332
Name:PEREYRA, BUENAVENTURA CARMEN (MD)
Entity type:Individual
Prefix:
First Name:BUENAVENTURA
Middle Name:CARMEN
Last Name:PEREYRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4433 BYRON CENTER AVE SW
Mailing Address - Street 2:PEDIATRICS PRIMARY CARE
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519-4844
Mailing Address - Country:US
Mailing Address - Phone:646-509-4511
Mailing Address - Fax:
Practice Address - Street 1:4433 BYRON CENTER AVE SW
Practice Address - Street 2:PEDIATRICS PRIMARY CARE
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-4844
Practice Address - Country:US
Practice Address - Phone:646-509-4511
Practice Address - Fax:616-530-2854
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR27138Medicare UPIN