Individual provider Active NPI

Mayra Crystal Perez Martinez

  • Rehabilitation Practitioner
  • San Jose, CA
National Provider Identifier
1164296687
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation PractitionerTaxonomy code 225400000X
Practice address
2090 Evans LN
San Jose, CA 95125-2072
Phone
(408) 793-2400
Fax
(408) 448-1815
NPI assigned
Nov 15, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X R1537371123 CA
Community/Behavioral Health Agency 251S00000X R1537371123 CA
Rehabilitation Practitioner 225400000X CA Primary

Addresses

Primary practice location

2090 Evans LN
San Jose, CA 95125-2072

Mailing address

2090 Evans LN
San Jose, CA 95125-2072
Phone (408) 793-2400

Other practice location 1

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

LicenseStateTypeSpecialty
R1537371123CAMDCommunity/Behavioral Health Agency

NPI Registry JSON

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

{
    "created_epoch": "1700006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784160000000",
    "number": "1164296687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2090 EVANS LN",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951252072",
            "telephone_number": "408-793-2400",
            "fax_number": "408-448-1815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2090 EVANS LN",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951252072",
            "telephone_number": "408-793-2400",
            "fax_number": "408-448-1815"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "160 E Virginia St Ste 100",
            "address_purpose": "LOCATION",
            "city": "San Jose",
            "state": "CA",
            "postal_code": "951125865",
            "country_code": "US",
            "telephone_number": "408-938-2113",
            "fax_number": "408-579-6143",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEREZ MARTINEZ",
        "first_name": "MAYRA",
        "middle_name": "CRYSTAL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-11-15",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "R1537371123",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "CA",
            "license": "R1537371123",
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": "CA",
            "license": null,
            "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 Jul 16, 2026; 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.