Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 707705 | TX |
NPI | 1093294654 |
---|---|
Provider Name | Elva Linda Pereida |
First Address | Robstown, TX 78380 |
Second Address | Portland, TX 78374-4144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2018 |
Last Update Date | 14/08/2018 |