Healthcare Provider Details

I. General information

NPI: 1497338933
Provider Name (Legal Business Name): MATTHEW PERIERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9225 CRESCENT CLOVER DR
KLEIN TX
77379-8590
US

IV. Provider business mailing address

22319 DESERT WILLOW DR
MAGNOLIA TX
77355-6207
US

V. Phone/Fax

Practice location:
  • Phone: 559-415-5617
  • Fax:
Mailing address:
  • Phone: 559-415-5617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number119837
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number4678
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number15724
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: