MEDICARE: MS. LINDA ANN RAYNES MAHONY MS.RD. CDE.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133VN1006X	Metabolic Nutrition Registered Dietitian	370262

General Provider Information

NPI Number	:	1467529479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LINDA ANN RAYNES MAHONY MS.RD. CDE.

Provider Business Mailing Address
First Line	:	6986 CAMINO REVUELTOS
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-7642
Country	:	US
Telephone Number	:	858-565-2205
Fax Number	:	619-296-1852

Provider Business Practice Location Address
First Line	:	3500 5TH AVE STE 301
Second Line	:	U.C.S.D. CENTER FOR TRANSPLANTATION
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5020
Country	:	US
Telephone Number	:	619-574-8612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	03/24/2011

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