Active NPI
Elyse W Perez
- Addiction (Substance Use Disorder) Counselor
- Fontana, CA
National Provider Identifier
1902295322
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 195424-III
- Practice address
- 17830 Arrow Blvd
Fontana, CA 92335-4037 - Phone
- (909) 356-6439
- Fax
- (909) 428-6450
- NPI assigned
- Jan 22, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | |||
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 195424-III | CA | Primary |
Addresses
Primary practice location
17830 Arrow Blvd
Fontana, CA 92335-4037
Mailing address
829 Post St
Redlands, CA 92374-4436
Phone (909) 991-3831
Other practice location 1
1076 Santo Antonio Dr
Suite B
Colton, CA 92324-8103
Phone (909) 433-9824 ext. 109
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | elyse.perez@dbh.sbcounty.gov | Direct |
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 |
|---|---|---|---|
| 195424-III | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613520000000",
"number": "1902295322",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "829 POST ST",
"city": "REDLANDS",
"state": "CA",
"postal_code": "923744436",
"telephone_number": "909-991-3831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17830 ARROW BLVD",
"city": "FONTANA",
"state": "CA",
"postal_code": "923354037",
"telephone_number": "909-356-6439",
"fax_number": "909-428-6450"
}
],
"practiceLocations": [
{
"address_1": "1076 Santo Antonio Dr",
"address_2": "Suite B",
"address_purpose": "LOCATION",
"city": "Colton",
"state": "CA",
"postal_code": "923248103",
"country_code": "US",
"telephone_number": "909-433-9824 x109",
"fax_number": "909-433-9830",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PEREZ",
"first_name": "ELYSE",
"middle_name": "W",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-01-22",
"last_updated": "2021-02-17",
"certification_date": "2021-02-17",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "195424-III",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "elyse.perez@dbh.sbcounty.gov",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "17830 Arrow Blvd",
"city": "Fontana",
"state": "CA",
"country_code": "US",
"postal_code": "923354037",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fontana, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.