Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Marie Lyn Custodio, NURSEPRACTITIONER

Individual provider Nurse Practitioner · NPI 1356981526

Marie Lyn Custodio, NURSEPRACTITIONER is a Nurse Practitioner in San Diego, California. Qualified in 2019, 7 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in California.

Years since qualifying
7
Licensed in
CA
In the registry since
2020
Specialties on file
2
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Practice location Address checks out

3327 Rosecrans St
San Diego, CA 92110-4223
Phone: (619) 225-9691
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 2760 Fletcher Pkwy, El Cajon, CA 92020-2110 — (619) 461-4411
  • 1419 E 8th St, National City, CA 91950-2602 — (619) 718-1743

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 95013240 (CA)
Nurse Practitioner Taxonomy 363L00000X · Licence 80555 (CA)

Record details

NPI number1356981526
Entity typeIndividual (Type 1)
GenderFemale
Credentials NURSEPRACTITIONER
Sole proprietorYes
NPI enumeratedJanuary 15, 2020
Last updated in NPPESOctober 21, 2021
Certification dateOctober 21, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in San Diego