Maryse S Ethier, RD

Primary specialty

Obesity and Weight Management Nutrition Registered DietitianTaxonomy code 133VN1201X

License

86115712 Issued in GA

Practice address

3841 Basilone St Unit 4
San Diego, CA 92110-5409

Phone

(706) 830-1159

NPI assigned

Feb 2, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1612224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1356932297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3841 BASILONE ST UNIT 4",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921105409",
            "telephone_number": "706-830-1159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3841 BASILONE ST UNIT 4",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921105409",
            "telephone_number": "706-830-1159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHIER",
        "first_name": "MARYSE",
        "middle_name": "S",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-02",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133VN1201X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered, Nutrition, Obesity and Weight Management",
            "state": "GA",
            "license": "86115712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CDR",
            "identifier": "86115712",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "laptop",
            "affiliation": "N",
            "endpointDescription": "Microsoft surface laptop",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3841 Basilone St Unit 4",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921105409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Ethos Medical Associates P.C.
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• Samatra L. Ethridge
• Michelle Etienne
• Moise Etienne, BS

• Obesity and Weight Management Nutrition Registered Dietitian in San Diego, CA
• Providers in San Diego, CA by specialty
• Obesity and Weight Management Nutrition Registered Dietitian in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.