Healthcare Provider Details

I. General information

NPI: 1366732182
Provider Name (Legal Business Name): CARLOS ALBERTO PEREIRA MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 SW 153RD CT APT 201
MIAMI FL
33193-1792
US

IV. Provider business mailing address

7611 SW 153RD CT APT 201
MIAMI FL
33193-1792
US

V. Phone/Fax

Practice location:
  • Phone: 813-802-2246
  • Fax:
Mailing address:
  • Phone: 813-802-2246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License NumberMA 62535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: