Active NPI
Marina E Perez, RN NP
- Adult Health Nurse Practitioner
- San Luis Obispo, CA
National Provider Identifier
1710065461
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 212720
- Practice address
- 1 Grand Ave.
Cal Poly Health Services
San Luis Obispo, CA 93407 - Phone
- (805) 756-5280
- Fax
- (805) 756-5280
- NPI assigned
- Nov 1, 2006
- 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 212720 | CA | Primary |
Addresses
Primary practice location
1 Grand Ave.
Cal Poly Health Services
San Luis Obispo, CA 93407
Mailing address
1930 Oceanaire Dr
San Luis Obispo, CA 93405-6829
Phone (805) 756-5280
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
- Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 212720 | CA | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710065461",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1930 OCEANAIRE DR",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "934056829",
"telephone_number": "805-756-5280",
"fax_number": "805-756-5298"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 GRAND AVE.",
"address_2": "CAL POLY HEALTH SERVICES",
"city": "SAN LUIS OBISPO",
"state": "CA",
"postal_code": "93407",
"telephone_number": "805-756-5280",
"fax_number": "805-756-5280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEREZ",
"first_name": "MARINA",
"middle_name": "E",
"credential": "RN NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "CA",
"license": "212720",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in San Luis Obispo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.