Individual provider Active NPI

Maria Lourdes De Los Santos Mara, M.D.

  • Internal Medicine Physician
  • San Diego, CA
National Provider Identifier
1376515924
Registry record updated Apr 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A51864 Issued in CA
Practice address
2939 Alta View Dr
Suite J
San Diego, CA 92139-3394
Phone
(619) 475-5411
Fax
(619) 475-1839
NPI assigned
Feb 7, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 20, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A51864 CA Primary

Addresses

Primary practice location

2939 Alta View Dr
Suite J
San Diego, CA 92139-3394

Mailing address

2939 Alta View Dr
Suite J
San Diego, CA 92139-3394
Phone (619) 475-5411

Other identifiers 1

IdentifierTypeStateIssuer
00A518642MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100817001431 CA Practitioner - Internal Medicine 8628102258 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2939 Alta View Dr
Suite J
San Diego, CA 92139-3394
Phone (619) 475-5411

2939 Alta View Dr J
San Diego, CA 92139-3394

Hospital & facility affiliations

  • A Better Solution in Home Care Home health agency, San Diego, CA, CCN 053116
  • Paradise Valley Hospital Hospital, National City, CA, CCN 050024
  • Sharp Chula Vista Medical Center Hospital, Chula Vista, CA, CCN 050222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A51864CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sharp Chula Vista Medical Center Past Accepting new patients
Paradise Valley Hospital Past Accepting new patients
Scripps Health Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492646400000",
    "number": "1376515924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2939 ALTA VIEW DR",
            "address_2": "SUITE J",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921393394",
            "telephone_number": "619-475-5411",
            "fax_number": "619-475-1839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2939 ALTA VIEW DR",
            "address_2": "SUITE J",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921393394",
            "telephone_number": "619-475-5411",
            "fax_number": "619-475-1839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARA",
        "first_name": "MARIA LOURDES",
        "middle_name": "DE LOS SANTOS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-02-07",
        "last_updated": "2017-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A51864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A518642",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.