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

Marivic Rustia

Individual provider Acute Care Nurse Practitioner · NPI 1376012104

Marivic Rustia is a Nurse Practitioner in Portland, Oregon. Qualified in 2017, 9 years ago. Practices with Legacy Clinics LLC, a 718-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Texas.

Years since qualifying
9
Licensed in
TX
In the registry since
2018
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Practice location Address checks out

2222 NW Lovejoy St Ste 411
Portland, OR 97210-5102
Phone: (503) 413-5598
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Acute Care Nurse Practitioner (primary) Taxonomy 363LA2100X · Licence AP139794 (TX)

Record details

NPI number1376012104
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 21, 2018
Last updated in NPPESOctober 12, 2021
Certification dateOctober 12, 2021

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Legacy Clinics Llc — 718 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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