Individual provider Active NPI

Czarinabelle Perez

  • Physician Assistant
  • Stockton, CA
National Provider Identifier
1073352449
Registry record updated Jun 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2626 N California St Ste B
Stockton, CA 95204-5500
Phone
(209) 466-2626
NPI assigned
May 23, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary
Medical Physician Assistant 363AM0700X

Addresses

Primary practice location

2626 N California St Ste B
Stockton, CA 95204-5500

Mailing address

3200 5TH Ave
Sacramento, CA 95817-2705

Other practice location 1

1325 Melrose Ave
Modesto, CA 95350-5581
Phone (209) 524-7000

Other practice location 2

801 S Ham Ln Ste S
Lodi, CA 95242-7503
Phone (209) 366-2616

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241017003350 CA Practitioner - Physician Assistant 2466984257 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mark Twain Medical Center CurrentSince Apr 17, 2025 Accepting new patients

Locations

768 Mountain Ranch Rd
San Andreas, CA 95249
Phone (209) 464-6422

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1716422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718064000000",
    "number": "1073352449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 5TH AVE",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2626 N CALIFORNIA ST STE B",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045500",
            "telephone_number": "209-466-2626"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1325 Melrose Ave",
            "address_purpose": "LOCATION",
            "city": "Modesto",
            "state": "CA",
            "postal_code": "953505581",
            "country_code": "US",
            "telephone_number": "209-524-7000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 S Ham Ln Ste S",
            "address_purpose": "LOCATION",
            "city": "Lodi",
            "state": "CA",
            "postal_code": "952427503",
            "country_code": "US",
            "telephone_number": "209-366-2616",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "CZARINABELLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-23",
        "last_updated": "2024-06-11",
        "certification_date": "2024-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockton, CA

Sources for this page

Verify at the official NPI Registry.