Basic Information
| Provider Information | |||||||||
| NPI: | 1053421776 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREIRA | ||||||||
| FirstName: | BENVINDA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3815 E BELL RD STE 2200 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850322139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026333838 | ||||||||
| FaxNumber: | 6026333845 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 N. CENTRAL BLVD. | ||||||||
| Address2: | SUITE #5 | ||||||||
| City: | QUARTZSITE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 85346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9289276105 | ||||||||
| FaxNumber: | 9289276110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | RN115611 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AP1431 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 641474 | 05 | AZ | MEDICAID | Z164332 | 01 | AZ | MEDICARE | OTHER | CG7880 | 01 | AZ | MEDICARE RAILROAD GROUP | OTHER | AZ0147610 | 01 | AZ | BCBS | OTHER | P00235241 | 01 | AZ | MEDICARE RAILROAD | OTHER |