Provider Demographics
NPI:1467044206
Name:MOTA PEREIRA, CANDIDO MIGUEL (RN)
Entity Type:Individual
Prefix:
First Name:CANDIDO
Middle Name:MIGUEL
Last Name:MOTA PEREIRA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COVENTRY
Mailing Address - State:RI
Mailing Address - Zip Code:02816-5861
Mailing Address - Country:US
Mailing Address - Phone:401-248-8055
Mailing Address - Fax:
Practice Address - Street 1:21 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:COVENTRY
Practice Address - State:RI
Practice Address - Zip Code:02816-5861
Practice Address - Country:US
Practice Address - Phone:401-248-8055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN61534163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse