Active NPI
Mary Karissa Potorski, RD, RDN
- Registered Dietitian
- San Diego, CA
National Provider Identifier
1912729690
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- Practice address
- 2907 Shelter Island Dr Ste 105
San Diego, CA 92106-2797 - Phone
- (570) 574-8793
- NPI assigned
- Oct 24, 2024
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | Primary |
Addresses
Primary practice location
2907 Shelter Island Dr Ste 105
San Diego, CA 92106-2797
Mailing address
2907 Shelter Island Dr Ste 105
San Diego, CA 92106-2797
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1729728000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729728000000",
"number": "1912729690",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2907 SHELTER ISLAND DR STE 105",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921062797"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2907 SHELTER ISLAND DR STE 105",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921062797",
"telephone_number": "570-574-8793"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POTORSKI",
"first_name": "MARY",
"middle_name": "KARISSA",
"credential": "RD, RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-10-24",
"last_updated": "2024-10-24",
"certification_date": "2024-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.