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General NPI Number Information
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NPI Number | 1992884332
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Entity Type | Individual
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Provider Name | BUENAVENTURA CARMEN PEREYRA M.D
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Gender | Female
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Dates
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Enumeration Date | 11/05/2006
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Last Update Date | 03/29/2008
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Provider Practice Location Address
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Address Line | 4433 BYRON CENTER AVE SW PEDIATRICS PRIMARY CARE
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City | WYOMING
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State | MI
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Zip | 49519-4844
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Country | US
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Telephone | 646-509-4511
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Fax | 616-530-2854
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Provider Business Mailing Address
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Address Line | 4433 BYRON CENTER AVE SW PEDIATRICS PRIMARY CARE
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City | WYOMING
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State | MI
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Zip | 49519-4844
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Country | US
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Telephone | 646-509-4511
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 5851
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License Number State | PR
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