1437535218 NPI number — PATRICIA NOBREGA RODRIGUES PEREIRA D.D.S., PHD

Table of content: PATRICIA NOBREGA RODRIGUES PEREIRA D.D.S., PHD (NPI 1437535218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437535218 NPI number — PATRICIA NOBREGA RODRIGUES PEREIRA D.D.S., PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREIRA
Provider First Name:
PATRICIA
Provider Middle Name:
NOBREGA RODRIGUES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.D.S., PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437535218
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100415
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32610-0415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-273-5850
Provider Business Mailing Address Fax Number:
352-846-1643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1395 CENTER DRIVE
Provider Second Line Business Practice Location Address:
ROOM D9-6
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-273-5850
Provider Business Practice Location Address Fax Number:
352-846-1643
Provider Enumeration Date:
08/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  DTP612 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 022135600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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