Active NPI
Mara Bustos
- Registered Dietitian
- San Francisco, CA
National Provider Identifier
1053031302
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 6156
- Practice address
- 595 Pacific Ave
San Francisco, CA 94133-4681 - Phone
- (415) 800-2311
- NPI assigned
- Aug 29, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 6156 | FL | Primary |
Addresses
Primary practice location
595 Pacific Ave
San Francisco, CA 94133-4681
Mailing address
PO Box 20076
West Palm Beach, FL 33416-0076
Phone (561) 317-5837
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6156 | FL | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bradley Management LLC | Dietitian, Registered | Past | Accepting new patients |
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661731200000",
"number": "1053031302",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 20076",
"city": "WEST PALM BEACH",
"state": "FL",
"postal_code": "334160076",
"telephone_number": "561-317-5837"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "595 PACIFIC AVE",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941334681",
"telephone_number": "415-800-2311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUSTOS",
"first_name": "MARA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-29",
"last_updated": "2022-08-29",
"certification_date": "2022-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "FL",
"license": "6156",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.