Active NPI
Jacqueline Andrea Perez, PT
- Physical Therapist
- Berkeley, CA
National Provider Identifier
1639115660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 34172
- Practice address
- 2030 Addison St Ste 101
Berkeley, CA 94704-1140 - Phone
- (510) 644-8031
- Fax
- (510) 644-8036
- NPI assigned
- Jun 20, 2006
- Last updated
- Oct 2, 2017
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 34172 | CA | Primary |
Addresses
Primary practice location
2030 Addison St Ste 101
Berkeley, CA 94704-1140
Mailing address
2030 Addison St Ste 101
Berkeley, CA 94704-1140
Phone (510) 644-8031
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34172 | CA | MD | Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Interventional Center for Pain | Past | Accepting new patients | |
| Medical Care LLC | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba center for interventional pain management
- Specialist
- Saint Louis, MO
- NPI 1508067208
-
- Health Service Clinic/Center
- Florissant, MO
- NPI 1609481696
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150761600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506902400000",
"number": "1639115660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2030 ADDISON ST STE 101",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947041140",
"telephone_number": "510-644-8031",
"fax_number": "510-644-8036"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2030 ADDISON ST STE 101",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947041140",
"telephone_number": "510-644-8031",
"fax_number": "510-644-8036"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ",
"first_name": "JACQUELINE",
"middle_name": "ANDREA",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-20",
"last_updated": "2017-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "34172",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Berkeley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.