CHRISTIAN CUSTODIO FNP
NPI 1811502404
Nurse Practitioner - Primary Care in Pomona, CA
About Christian Custodio Fnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CHRISTIAN CUSTODIO FNP (NPI 1811502404) is an individual primary care provider in Pomona, California, licensed in California (95015354) and active in the NPI registry since September 2020. He is enrolled in Medicare PECOS and is a graduate of Other (2020).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Christian Custodio Fnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Medicare Billing Reassignment
Medicare enrollment records show Christian Custodio reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Pomona, CA 91768
- Reassigned Medicare billing, California enrollment
- 7 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Areas of Expertise CMS Part B claims
Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 91768 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Referred Medical Equipment & Supplies CMS DME claims
Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.
Other Providers at the Same Location NPPES 8
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Christian Custodio's NPI number?
The NPI number for Christian Custodio is 1811502404. It was assigned to this individual provider in the NPPES registry on September 10, 2020.
Where is Christian Custodio located?
Christian Custodio practices at 1196 N Park Ave, Pomona, CA 91768. The listed phone number is (909) 623-4050.
What is Christian Custodio's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Primary Care, with taxonomy code 363LP2300X.
Is Christian Custodio enrolled in Medicare?
Yes. Christian Custodio is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
Which organization bills Medicare for Christian Custodio's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Christian Custodio reassigns Medicare benefits to Mallu Reddy MD Inc (Pomona, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Christian Custodio's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Christian Custodio was last updated on September 10, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Christian Custodio, FNP · NPI 1811502404
Primary Care physician in Pomona, California. Individual provider, active in the CMS NPPES registry since September 10, 2020.
## Identity
- **NPI:** 1811502404 (Entity type: Individual)
- **Enumerated:** September 10, 2020
- **Primary specialty:** Nurse Practitioner - Primary Care · taxonomy 363LP2300X
- **State license:** 95015354 (California)
- **Sole proprietor:** No
## Practice location
- **Address:** 1196 N PARK AVE, Pomona, CA 91768-3027
- **Phone:** (909) 623-4050
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Mallu Reddy MD Inc (NPI 1902111834, Pomona, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2020
## Record status
- **NPPES last updated:** September 10, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1811502404) · Data from the CMS NPPES public registry.