Provider Demographics
NPI:1497338933
Name:PERIERA, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:PERIERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12303 S RAVEN SHORE CT
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-2420
Mailing Address - Country:US
Mailing Address - Phone:559-415-5617
Mailing Address - Fax:
Practice Address - Street 1:9225 CRESCENT CLOVER DR
Practice Address - Street 2:
Practice Address - City:KLEIN
Practice Address - State:TX
Practice Address - Zip Code:77379-8590
Practice Address - Country:US
Practice Address - Phone:559-415-5617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46782355S0801X
CA33617235Z00000X
CA15724235Z00000X
TX119837235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant