Active NPI
Jose Ignacio Perea
- Endodontics
- Los Angeles, CA
National Provider Identifier
1407334683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 48537
- Practice address
- 12300 Wilshire Blvd Ste 404
Los Angeles, CA 90025-1061 - Phone
- (310) 207-2272
- Fax
- (424) 293-2623
- NPI assigned
- Jul 31, 2018
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 48537 | CA | Primary |
Addresses
Primary practice location
12300 Wilshire Blvd Ste 404
Los Angeles, CA 90025-1061
Mailing address
12300 Wilshire Blvd Ste 404
Los Angeles, CA 90025-1061
Phone (310) 207-2272
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942536586 | Medicaid | CA |
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 |
|---|---|---|---|
| 48537 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jose Ignacio Perea Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dental Clinic/Center
- Los Angeles, CA
- NPI 1942536586
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1532995200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1532995200000",
"number": "1407334683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12300 WILSHIRE BLVD STE 404",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251061",
"telephone_number": "310-207-2272",
"fax_number": "424-293-2623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12300 WILSHIRE BLVD STE 404",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900251061",
"telephone_number": "310-207-2272",
"fax_number": "424-293-2623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREA",
"first_name": "JOSE",
"middle_name": "IGNACIO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-31",
"last_updated": "2018-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "48537",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1942536586",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.