Provider Demographics
NPI:1427364991
Name:DR FERNANDO PEREZ MAGNELLI LLC
Entity Type:Organization
Organization Name:DR FERNANDO PEREZ MAGNELLI LLC
Other - Org Name:SINAPSIS PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:VALARIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:GERSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PRACTICE MANAGER
Authorized Official - Phone:636-887-0914
Mailing Address - Street 1:207 CREEKSIDE OFFICE DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3290
Mailing Address - Country:US
Mailing Address - Phone:636-877-0914
Mailing Address - Fax:636-206-2522
Practice Address - Street 1:207 CREEKSIDE OFFICE DR
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3290
Practice Address - Country:US
Practice Address - Phone:636-877-0914
Practice Address - Fax:636-206-2522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001655792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1427364991Medicaid
MO1427364991Medicaid