Individual provider Active NPI

Marina E Perez, RN NP

  • Adult Health Nurse Practitioner
  • San Luis Obispo, CA
National Provider Identifier
1710065461
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
212720 Issued in CA
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

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
212720CAMDAdult 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.

Verify at the official NPI Registry.