Healthcare Provider Details

I. General information

NPI: 1679481907
Provider Name (Legal Business Name): CLEAR BLUE NUTRITION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 OLIVE DR STE D1
DAVIS CA
95616-4740
US

IV. Provider business mailing address

1520 E COVELL BLVD STE B5
DAVIS CA
95616-1366
US

V. Phone/Fax

Practice location:
  • Phone: 916-572-5122
  • Fax:
Mailing address:
  • Phone: 916-572-5122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MARY BLUE
Title or Position: CEO
Credential: RDN
Phone: 916-572-5122