Active NPI
Solomon Ezekiel Perez, B.A
- Peer Specialist
- San Diego, CA
National Provider Identifier
1558872739
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- Practice address
- 3539 College Ave
San Diego, CA 92115-7032 - Phone
- (619) 818-3788
- NPI assigned
- Oct 16, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CA | ||
| Peer Specialist | 175T00000X | CA | Primary |
Addresses
Primary practice location
3539 College Ave
San Diego, CA 92115-7032
Mailing address
1031 25TH St
San Diego, CA 92102-2102
Phone (619) 232-6454
Other practice location 1
865 3rd Ave Ste 112
Chula Vista, CA 91911-1300
Phone (619) 232-6454
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3704 | 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
- Credentials
- Bachelor of Arts
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1508112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1643155200000",
"number": "1558872739",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1031 25TH ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921022102",
"telephone_number": "619-232-6454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3539 COLLEGE AVE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921157032",
"telephone_number": "619-818-3788"
}
],
"practiceLocations": [
{
"address_1": "865 3rd Ave Ste 112",
"address_purpose": "LOCATION",
"city": "Chula Vista",
"state": "CA",
"postal_code": "919111300",
"country_code": "US",
"telephone_number": "619-232-6454",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PEREZ",
"first_name": "SOLOMON",
"middle_name": "EZEKIEL",
"credential": "B.A",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-16",
"last_updated": "2022-01-26",
"certification_date": "2022-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": null,
"primary": false
},
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3704",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.