Individual
ISMAEL PEREIRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4600 MONTGOMERY BLVD NE # B, ALBUQUERQUE, NM 87109
(505) 924-5840
(505) 924-5841
Mailing address
PO BOX 91224, ALBUQUERQUE, NM 87199-1224
(505) 924-5840
(505) 924-5841
Taxonomy
Speciality
Code
Description
License number
State
202K00000X
Phlebology Physician
Primary
PA2016-0096
NM
363AM0700X
Medical Physician Assistant
PA20160096
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA20160096
—
NM
Enumeration date
10/20/2016
Last updated
07/28/2022
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