Healthcare Provider Details

I. General information

NPI: 1336864305
Provider Name (Legal Business Name): ALEX EDWARD PEREIRA ND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 BROADWAY STE 1A
SAN FRANCISCO CA
94109-2539
US

IV. Provider business mailing address

8559 MORNING SKYE WAY
ANTELOPE CA
95843-5408
US

V. Phone/Fax

Practice location:
  • Phone: 916-351-9355
  • Fax: 415-292-7911
Mailing address:
  • Phone: 916-607-5307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: