Provider Demographics
NPI:1093294654
Name:PEREIDA, ELVA LINDA (BSN, RN, CPN)
Entity Type:Individual
Prefix:
First Name:ELVA
Middle Name:LINDA
Last Name:PEREIDA
Suffix:
Gender:F
Credentials:BSN, RN, CPN
Other - Prefix:
Other - First Name:ELVA
Other - Middle Name:
Other - Last Name:PEREIDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BSN, RN, CPN
Mailing Address - Street 1:3725 AMANDA LANE
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380
Mailing Address - Country:US
Mailing Address - Phone:361-441-9515
Mailing Address - Fax:
Practice Address - Street 1:107 PALISADES
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-4144
Practice Address - Country:US
Practice Address - Phone:361-441-9515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7077052080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine