Andre Ederson Haynesworth Pereira

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

14400-RAC Issued in CA

Practice address

2980 Cedar St
San Diego, CA 92102-1599

Phone

(619) 239-7370

NPI assigned

Dec 14, 2020

Last updated

Dec 14, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Pathfinders of San Diego

  • Substance Abuse Rehabilitation Facility
  • San Diego, CA
  • NPI 1285138230
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607904000000",
    "number": "1841886892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 CEDAR ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921021599",
            "telephone_number": "619-239-7370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2980 CEDAR ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921021599",
            "telephone_number": "619-239-7370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYNESWORTH PEREIRA",
        "first_name": "ANDRE",
        "middle_name": "EDERSON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-14",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "14400-RAC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Scott Haynes, MD
• Kiarra Patrece Haynes
• Kiyah Breyon Haynes
• Molly Haynes, MSW
• Robert C Haynes, M.D.
• Jonathan Grant Haynie, DDS
• Van Spencer Haynie
• Anna Katherine Hays, NNP
• Caitlin Hays
• Jeffry Hays, D.C.

• Addiction (Substance Use Disorder) Counselor in San Diego, CA
• Providers in San Diego, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.