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General NPI Number Information
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NPI Number | 1083690853
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Entity Type | Individual
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Provider Name | REYNALDO JORGE PEREIRA SURGICAL ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 12/22/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 899 AMBLE RD
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City | SHOREVIEW
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State | MN
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Zip | 55126-2230
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Country | US
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Telephone | 651-481-8144
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Fax |
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Provider Business Mailing Address
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Address Line | 899 AMBLE RD
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City | SHOREVIEW
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State | MN
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Zip | 55126-2230
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Country | US
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Telephone | 651-481-8144
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246X00000X
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Taxonomy Name | Cardiovascular Specialist/Technologist
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License Number | 1506 ( CERTIF.)
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License Number State | VA
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