Basic Information
| Provider Information | |||||||||
| NPI: | 1316941925 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREIRA | ||||||||
| FirstName: | NICHOLAS | ||||||||
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| Credential: | MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5111 N 10TH ST | ||||||||
| Address2: | # 112 | ||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785042835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566319739 | ||||||||
| FaxNumber: | 9566316717 | ||||||||
| Practice Location | |||||||||
| Address1: | 1102 W TRENTON RD | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785399105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563886000 | ||||||||
| FaxNumber: | 9562892956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 01/27/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | K3389 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | K3389 | TX | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 0029XR | 01 | TX | BC/BS | OTHER | 190654701 | 05 | TX | MEDICAID |