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

Q: What is the provider's specialty?

The provider's specialty is Nurse Practitioner with taxonomy code 363LF0000X and a focus in Family.

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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.