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General NPI Number Information
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NPI Number | 1568358950
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Entity Type | Organization
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Legal Business Name | CLEAR BLUE NUTRITION LLC
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 10 COLLEGE PARK
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City | DAVIS
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State | CA
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Zip | 95616-3607
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Country | US
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Telephone | 916-572-5122
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Fax | 530-298-2918
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Provider Business Mailing Address
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Address Line | 1520 E COVELL BLVD STE B5
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City | DAVIS
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State | CA
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Zip | 95616-1366
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Country | US
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Telephone | 916-572-5122
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Fax | 530-298-2918
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | MARY C BLUE
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Credential | RDN
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Telephone | 916-572-5122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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