Healthcare Provider Details

I. General information

NPI: 1679967657
Provider Name (Legal Business Name): REGINALD PEREIRA JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 NW 37TH AVE FL 2
MIAMI FL
33125-4826
US

IV. Provider business mailing address

198 NW 37TH AVE FL 2
MIAMI FL
33125-4826
US

V. Phone/Fax

Practice location:
  • Phone: 305-267-5544
  • Fax: 305-500-2133
Mailing address:
  • Phone: 305-267-5544
  • Fax: 305-500-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number297686
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME136598
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME136598
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME136598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: