Healthcare Provider Details

I. General information

NPI: 1437272440
Provider Name (Legal Business Name): BETHANIE ERIN PEREIRA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N. TUSTIN AVE
SANTA ANA CA
92705
US

IV. Provider business mailing address

1301 N TUSTIN AVE
SANTA ANA CA
92705-8619
US

V. Phone/Fax

Practice location:
  • Phone: 174-953-3331
  • Fax: 714-953-4542
Mailing address:
  • Phone: 714-953-3331
  • Fax: 714-953-4542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number38101
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberC55815
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: