Provider Demographics
NPI:1912886490
Name:PEPPERS, MICHAEL ANGELO
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANGELO
Last Name:PEPPERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5473 KEARNY VILLA RD STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1142
Mailing Address - Country:US
Mailing Address - Phone:858-298-7347
Mailing Address - Fax:619-684-7004
Practice Address - Street 1:5473 KEARNEY VILLA RD STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-9212
Practice Address - Country:US
Practice Address - Phone:858-298-7347
Practice Address - Fax:619-684-7004
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-29
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22900101YA0400X
CA225400000X
175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No175T00000XOther Service ProvidersPeer Specialist