Active NPI
Johanna Paula Custodio
- Professional Counselor
- Azusa, CA
National Provider Identifier
1265244248
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 17989
- Practice address
- 313 N Fenimore Ave
Azusa, CA 91702-3924 - Phone
- (714) 696-1295
- NPI assigned
- Jan 24, 2025
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 17989 | CA | Primary |
Addresses
Primary practice location
313 N Fenimore Ave
Azusa, CA 91702-3924
Mailing address
110 W 6TH St
Azusa, CA 91702-6785
Phone (714) 696-1295
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17989 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1737676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1741478400000",
"number": "1265244248",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 W 6TH ST",
"city": "AZUSA",
"state": "CA",
"postal_code": "917026785",
"telephone_number": "714-696-1295"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "313 N FENIMORE AVE",
"city": "AZUSA",
"state": "CA",
"postal_code": "917023924",
"telephone_number": "714-696-1295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSTODIO",
"first_name": "JOHANNA PAULA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-01-24",
"last_updated": "2025-03-09",
"certification_date": "2025-03-09",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CA",
"license": "17989",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Azusa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.