Provider Demographics
NPI:1023210507
Name:PEREIRA, RAQUEL (RD)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 HIGHWAY 100 S
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1529
Mailing Address - Country:US
Mailing Address - Phone:651-645-5323
Mailing Address - Fax:952-746-5962
Practice Address - Street 1:112067 STONE CREEK DR
Practice Address - Street 2:
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2400
Practice Address - Country:US
Practice Address - Phone:952-361-4279
Practice Address - Fax:952-448-5622
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2652133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered