Provider Demographics
NPI:1689010084
Name:PEREYRA, MARIO FERNANDO (MOTR/L)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:FERNANDO
Last Name:PEREYRA
Suffix:
Gender:M
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:241 CONDO LN APT 712
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3145
Mailing Address - Country:US
Mailing Address - Phone:671-988-9651
Mailing Address - Fax:671-475-5855
Practice Address - Street 1:498 CHALAN PALOSYO
Practice Address - Street 2:
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96910-6427
Practice Address - Country:US
Practice Address - Phone:671-475-5801
Practice Address - Fax:671-475-5855
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2680225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist