Provider Demographics
NPI:1700835188
Name:PERA, ABRAHAM (DO)
Entity Type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:
Last Name:PERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6428
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95502-6428
Mailing Address - Country:US
Mailing Address - Phone:707-445-5431
Mailing Address - Fax:707-445-3710
Practice Address - Street 1:2330 BUHNE ST
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-442-3704
Practice Address - Fax:707-442-8986
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A56862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
300084585OtherRR MEDICARE
CA00AX56860Medicaid
CA00AX56860Medicaid
CA020A56861Medicare ID - Type Unspecified
020A56865Medicare PIN
020A56866Medicare PIN
E37490Medicare UPIN