Healthcare Provider Details

I. General information

NPI: 1740052646
Provider Name (Legal Business Name): MS. AMBER DAWN PEREIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2023
Last Update Date: 11/11/2023
Certification Date: 11/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3937 GRIFFITH AVE
CLOVIS CA
93619-7264
US

IV. Provider business mailing address

3726 GRAYSTOKE WAY
CLOVIS CA
93619-5296
US

V. Phone/Fax

Practice location:
  • Phone: 559-375-1314
  • Fax:
Mailing address:
  • Phone: 559-375-1413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: