Mariko Elizabeth Blumenfeld, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95006095 Issued in CA

Practice address

13690 E 14TH St Ste 200
San Leandro, CA 94578-2584

Phone

(510) 297-0550

Fax

(510) 297-0558

NPI assigned

Feb 21, 2017

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

• Mariko Elizabeth Lightner Former name

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Planned Parenthood Shasta Diablo Inc

  • Community Health Clinic/Center
  • Concord, CA
  • NPI 1982763090
  Medicare reassignment NPD
• Tri-Valley Orthopedic and Sports Medical Group Inc

  • Orthopaedic Surgery Physician
  • Pleasanton, CA
  • NPI 1184808156
  Medicare reassignment NPD
• Planned Parenthood Shasta Diablo Inc

  • Community Health Clinic/Center
  • Chico, CA
  • NPI 1558420695
  NPD
• Planned Parenthood Shasta Diablo Inc

  • Clinical Medical Laboratory
  • San Rafael, CA
  • NPI 1750435244
  NPD
• Tri-Valley Orthopedic and Sports Medical Group Inc

  • Orthopaedic Surgery Physician
  • San Ramon, CA
  • NPI 1801883731
  NPD

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

{
    "created_epoch": "1487635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649203200000",
    "number": "1750820965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4626 WILLOW RD",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945888517",
            "telephone_number": "866-623-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13690 E 14TH ST STE 200",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945782584",
            "telephone_number": "510-297-0550",
            "fax_number": "510-297-0558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLUMENFELD",
        "first_name": "MARIKO",
        "middle_name": "ELIZABETH",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-21",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95053145",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95006095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIKO",
            "last_name": "LIGHTNER",
            "middle_name": "ELIZABETH",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tyler Block
• Chelsea Rae Blom
• Bloom Together, LLC
• Blossom Healthcare, LLC
• Mary Ann Quarto Bloyer, C.N.M.
• Shanika Shalesse Blunt
• Arnold J Blustein, M.D.
• Megan Elizabeth Boesch
• Alexa Rae Boffoli
• Anne Jeanette Boheler

• Family Nurse Practitioner in San Leandro, CA
• Providers in San Leandro, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.