Provider Demographics
NPI:1083690853
Name:PEREIRA, REYNALDO JORGE (SURGICAL ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:REYNALDO
Middle Name:JORGE
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:SURGICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 AMBLE RD
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-2230
Mailing Address - Country:US
Mailing Address - Phone:651-481-8144
Mailing Address - Fax:
Practice Address - Street 1:899 AMBLE RD
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-2230
Practice Address - Country:US
Practice Address - Phone:651-481-8144
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1506 ( CERTIF.)246X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246X00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist Cardiovascular