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

MS. Mara Kamyl Perez Custodio, PA-C

Individual provider Physician Assistant · NPI 1932729829

MS. Mara Kamyl Perez Custodio, PA-C is a Physician Assistant in LA Jolla, California. Qualified in 2020, 6 years ago. Practices with Regents of the University of California, a 2,061-clinician group, works from 4 locations, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
6
Licensed in
CA
In the registry since
2020
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

9300 Campus Point Dr
LA Jolla, CA 92037-1300
Phone: (800) 926-8273
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (3)

  • 910 Vine St, Los Angeles, CA 90038-2702 — (866) 499-8252
  • 200 W Arbor Dr, San Diego, CA 92103-9000 — (800) 926-8273
  • 4303 La Jolla Village Dr, San Diego, CA 92122-1394 — (800) 926-8273

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 58937 (CA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1932729829
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedApril 20, 2020
Last updated in NPPESJanuary 27, 2025
Certification dateJanuary 27, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Regents Of The University Of California — 2061 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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