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General NPI Number Information
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NPI Number | 1093294654
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Entity Type | Individual
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Provider Name | ELVA LINDA PEREIDA BSN, RN, CPN
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Gender | Female
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 107 PALISADES
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City | PORTLAND
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State | TX
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Zip | 78374-4144
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Country | US
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Telephone | 361-441-9515
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Fax |
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Provider Business Mailing Address
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Address Line | 3725 AMANDA LANE
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City | ROBSTOWN
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State | TX
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Zip | 78380
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Country | US
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Telephone | 361-441-9515
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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 | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 707705
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License Number State | TX
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