Mara Da Luz Bernardo, RDN, CSO

Primary specialty

Oncology Nutrition Registered DietitianTaxonomy code 133VN1301X

License

86033078 Issued in CA

Practice address

415 W Benjamin Holt Dr Ste B3
Stockton, CA 95207-3958

Phone

(209) 227-0722

Fax

(866) 862-8832

NPI assigned

Jul 22, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mara Da Luz Owens Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Registered Dietitian Or Nutrition Professional

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Valley Registered Dietitian NetworkGroup PAC ID 8426449281, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Valley Registered Dietitian Network

  • Oncology Nutrition Registered Dietitian
  • Stockton, CA
  • NPI 1831855311

  Dietitian, Registered

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1255904512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 W BENJAMIN HOLT DR STE B3",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952073958",
            "telephone_number": "209-227-0722",
            "fax_number": "866-862-8832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 W BENJAMIN HOLT DR STE B3",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952073958",
            "telephone_number": "209-227-0722",
            "fax_number": "866-862-8832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERNARDO",
        "first_name": "MARA",
        "middle_name": "DA LUZ",
        "name_prefix": "Mrs.",
        "credential": "RDN, CSO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-22",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "CA",
            "license": "86033078",
            "primary": false
        },
        {
            "code": "133VN1301X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Oncology",
            "state": "CA",
            "license": "86033078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Maradrd90@gmail.com",
            "affiliation": "N",
            "endpointDescription": "business e-mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1233 Paloma Ave",
            "city": "Stockton",
            "state": "CA",
            "country_code": "US",
            "postal_code": "952093006",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARA",
            "last_name": "OWENS",
            "middle_name": "DA LUZ",
            "credential": "RDN, CSO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ila Bermodes
• Elizabeth Bermudez
• Christine Bernabe
• Pamela Bernal
• Allison Britney Igtanloc Bernardo, DO
• Marinette Gonzales Bernardo, MD
• Joseph William Bernstein
• Devonna Berry
• Michaela Berry
• Jackie Berryessa

• Registered Dietitian in Stockton, CA
• Providers in Stockton, CA by specialty
• Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.