Provider Demographics
NPI:1336864305
Name:PEREIRA, ALEX EDWARD (ND)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:EDWARD
Last Name:PEREIRA
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8559 MORNING SKYE WAY
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-5408
Mailing Address - Country:US
Mailing Address - Phone:916-607-5307
Mailing Address - Fax:
Practice Address - Street 1:254 GIBSON DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-5881
Practice Address - Country:US
Practice Address - Phone:916-351-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND1376175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath