Active NPI
Marina Pereverzeva
- Addiction (Substance Use Disorder) Counselor
- San Jose, CA
National Provider Identifier
1053043802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- R1485070922
- Practice address
- 160 E Virginia St Ste 100
San Jose, CA 95112-5865 - Phone
- (408) 938-2113
- Fax
- (408) 579-6143
- NPI assigned
- Jun 29, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | R1485070922 | CA | Primary |
Addresses
Primary practice location
160 E Virginia St Ste 100
San Jose, CA 95112-5865
Mailing address
160 E Virginia St Ste 100
San Jose, CA 95112-5865
Phone (408) 938-2113
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R1485070922 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703116800000",
"number": "1053043802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "160 E VIRGINIA ST STE 100",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951125865",
"telephone_number": "408-938-2113",
"fax_number": "408-579-6143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "160 E VIRGINIA ST STE 100",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951125865",
"telephone_number": "408-938-2113",
"fax_number": "408-579-6143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREVERZEVA",
"first_name": "MARINA",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-29",
"last_updated": "2023-12-21",
"certification_date": "2023-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "R1485070922",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.