MARIE LYN CUSTODIO (NPI# 1356981526) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356981526 |
| Entity Type | Individual |
| Full Name | MARIE LYN CUSTODIO |
| Credential | NURSE PRACTITIONER |
| Practice Address |
2760 Fletcher Pkwy El Cajon CA 92020-2110 |
| Mailing Address |
1326 Stearns Wharf Rd Chula Vista CA 91913-3289 |
| Practice Telephone | 6194614411 |
| Mailing Telephone | 6196327061 |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2020-07-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 80555 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1419 E 8th St, National City, CA 919502602 | 6197181743 |
| Street Address |
2760 FLETCHER PKWY |
| City | EL CAJON |
| State | CA |
| Zip Code | 92020-2110 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467496737 | Garfield Beach Cvs LLC | Pharmacy | 2760 Fletcher Pkwy, El Cajon, CA 92020-2110 | 2006-06-16 |
| 1558974519 | Kinjalben S Sharma | Pharmacist | 2760 Fletcher Pkwy, El Cajon, CA 92020-2110 | 2020-08-28 |
| 1366052847 | Chelsea Dawn Ovanek | Nurse Practitioner | 2760 Fletcher Pkwy, El Cajon, CA 92020-2110 | 2020-08-09 |
| 1184267411 | Jennifer Jade Kumala Ocegueda | Nurse Practitioner | 2760 Fletcher Pkwy, El Cajon, CA 92020-2110 | 2019-10-18 |
| 1780247148 | Araceli Lustina | Pharmacist | 2760 Fletcher Pkwy, El Cajon, CA 92020-2110 | 2019-04-20 |
| 1427516384 | Dennis Vince-cruz Deguzman | Nurse Practitioner | 2760 Fletcher Pkwy, El Cajon, CA 92020-2110 | 2019-03-08 |
| 1891252912 | Ramona Sevilla Fontela | Nurse Practitioner | 2760 Fletcher Pkwy, El Cajon, CA 92020-2110 | 2019-02-25 |
| 1801371810 | Valery Morgan | Nurse Practitioner | 2760 Fletcher Pkwy, El Cajon, CA 92020-2110 | 2018-09-26 |
| 1306357686 | Kathleen Willette Fitzgerald | Nurse Practitioner | 2760 Fletcher Pkwy, El Cajon, CA 92020-2110 | 2017-10-13 |
| 1841700093 | Dia Blythe | Nurse Practitioner | 2760 Fletcher Pkwy, El Cajon, CA 92020-2110 | 2017-10-02 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447877840 | Margarito Alejandro Torres | Behavior Technician | 1005 S. Sunshine Ave, El Cajon, CA 92020 | 2020-07-01 |
| 1619503166 | Stella Zeicu Varagic | Dentist | 2526 Fletcher Pkwy, El Cajon, CA 92020 | 2020-03-17 |
| 1548827819 | Unexpected Possibilities, Inc | Non-emergency Medical Transport (VAN) | 1015 El Cajon Blvd # A, El Cajon, CA 92020 | 2019-05-22 |
| 1083175707 | Maricela Uriarte D.d.s | Dentist | 164 W Park Ave, El Cajon, CA 92020 | 2019-03-26 |
| 1881153963 | Rubeleta Medina | Nurse Practitioner | 1908 Friendship Drive, El Cajon, CA 92020 | 2019-03-18 |
| 1235619800 | Melissa Gomez | Counselor | 1600 Cuyamaca St, El Cajo, CA 92020 | 2018-08-14 |
| 1013407790 | Erin Metcalf | Family Medicine | 133 W Main St., 240, El Cajon, CA 92020 | 2018-05-17 |
| 1326535220 | Diana Orozco | Counselor | 1870cordell Court, Suite 101, El Cajon, CA 92020 | 2018-04-16 |
| 1104330646 | Mercy Air Service, Inc. | Ambulance | 545 Kenney St Ste G1a, El Cajon, CA 92020 | 2017-11-20 |
| 1790296184 | Way Cool Homecare, Inc | In Home Supportive Care | 900 N. Cuyamaca Street, Ste 201, El Cajon, CA 92020 | 2017-10-12 |
| Find all providers in zip 92020 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831704113 | Brandon Michael Dittmar | Nurse Practitioner | 1380 Horsemill Rd, El Cajon, CA 92021-7807 | 2020-09-13 |
| 1457879132 | Tammy Chee Lu | Nurse Practitioner | 1111 E. Chase Avenue, El Cajon, CA 92020 | 2017-09-01 |
| 1649588005 | Anna Liza Celso Baston | Nurse Practitioner | 1465 E Lexington, Unit 10-c, El Cajon, CA 92019 | 2010-09-20 |
| 1881201721 | Gizzele Victoria Del Rosario Valencia | Nurse Practitioner | 133 W Main St Ste 100, El Cajon, CA 92020-3325 | 2020-09-24 |
| 1871961284 | Elen Yip Zepeda | Nurse Practitioner | 1625 E Main St, Suite 100, El Cajon, CA 92021-5211 | 2015-09-02 |
| 1922363977 | Nenette Brown | Nurse Practitioner | 165 S 1st St, El Cajon, CA 92019-4795 | 2012-07-05 |
| 1760595789 | Marcia L Stien | Nurse Practitioner | 1240 Broadway, El Cajon, CA 92021-4994 | 2006-08-16 |
| 1548292626 | Cynthia L Mangene | Nurse Practitioner | 1111 W Chase Ave, El Cajon, CA 92020-5710 | 2006-07-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114528817 | Gemekia Latrisha Morales | Nurse Practitioner | 1800 N. California, Stockton, CA 95952 | 2020-11-08 |
| 1447851324 | Anna Patricia Torres | Nurse Practitioner | 1158 Santa Lucia Dr, Pittsburg, CA 94565-7615 | 2020-11-05 |
| 1447851647 | Melanie Ganotisi | Nurse Practitioner | 11541 Blucher Ave Unit 125, Granada Hills, CA 91344-4362 | 2020-11-04 |
| 1659971729 | Raquel Y Mccarthy | Nurse Practitioner | 334 Via Vera Cruz Ste 257, San Marcos, CA 92078-2643 | 2020-10-28 |
| 1689274607 | Aleksandra Zaitseva | Nurse Practitioner | 6850 Sepulveda Blvd Ste 215, Van Nuys, CA 91405-4450 | 2020-10-28 |
| 1215537543 | Gereine Mae Condino Datan | Nurse Practitioner | 500 W 190 St, Gardena, CA 90248 | 2020-10-27 |
| 1861092355 | Vilma Estrada | Nurse Practitioner | 37945 28th St E, Palmdale, CA 93550-5521 | 2020-10-26 |
| 1871192492 | Folashade Jayeoba | Nurse Practitioner | 7453 Tucson Ln, Fontana, CA 92336-0712 | 2020-10-23 |
| 1467051391 | Careforyou LLC | Nurse Practitioner | 806 14th St, Modesto, CA 95354-1023 | 2020-10-21 |
| 1427657550 | Adriana Sarah Pettross | Nurse Practitioner | 35286 Vista De Todo, Capistrano Beach, CA 92624-1847 | 2020-10-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.