MARIE LYN CUSTODIO NURSE PRACTITIONER
NPI 1356981526
Nurse Practitioner - Family in San Diego, CA

Q: What is Marie Lyn Custodio's NPI number?

The NPI number for Marie Lyn Custodio is 1356981526. It was assigned to this individual provider in the NPPES registry on January 15, 2020.

Q: What is Marie Lyn Custodio's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Active since January 15, 2020PECOS Enrolled

3327 ROSECRANS ST, SAN DIEGO, CA 92110(619) 225-9691 Get Directions Write a Review

NPPES record last updated: October 21, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Oct 21, 2021, May 26, 2021, May 21, 2021 and 2 more (5 updates tracked since 2020).

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About Marie Lyn Custodio Nurse Practitioner NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARIE LYN CUSTODIO NURSE PRACTITIONER (NPI 1356981526) is an individual family provider in San Diego, California, licensed in California (95013240) and active in the NPI registry since January 2020. She is enrolled in Medicare PECOS and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1356981526

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameMARIE LYN CUSTODIOCredential: NURSE PRACTITIONER

Location Address3327 ROSECRANS STSan Diego, CA 92110-4223

Mailing Address3327 Rosecrans StSan Diego, CA 92110-4223 · (619) 225-9691

Phone(619) 225-9691

Sole ProprietorYes

Enumeration DateJanuary 15, 2020

Last NPPES UpdateOctober 21, 20215 updates tracked since enumeration

NPPES CertifiedOctober 21, 2021

✔ NPI 1356981526 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in CA · 95013240

Also ListedNurse PractitionerTaxonomy 363L00000X · License 80555 (CA)

3327 ROSECRANS ST, San Diego, CA 92110

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Secondary Practice Locations 2

Location 11419 E 8th StNational City, CA 91950-2602 · Phone (619) 718-1743

Location 22760 Fletcher PkwyEl Cajon, CA 92020-2110 · Phone (619) 461-4411 ext. 8221

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Marie Lyn Custodio Nurse Practitioner is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 92110 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$94.87 typical visit price

range $62.10 – $184.71

Typical copayment $23.71 (range $15.52 – $46.17)

Most-billed visit code 99203

Established Patient

$108.42 typical visit price

range $20.62 – $151.42

Typical copayment $27.10 (range $5.15 – $37.85)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KELLY SHAKYA

Nurse Practitioner (Family)