MEDICARE: MARY KATHRIN DUBOIS RD

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	133V00000X	Registered Dietitian	722761	CA

General Provider Information

NPI Number	:	1053041574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY KATHRIN DUBOIS RD

Provider Business Mailing Address
First Line	:	34162 CAPISTRANO BY THE SEA
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-2940
Country	:	US
Telephone Number	:	194-924-0433
Fax Number	:	949-240-4392

Provider Business Practice Location Address
First Line	:	34162 CAPISTRANO BY THE SEA
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-2940
Country	:	US
Telephone Number	:	949-240-4343
Fax Number	:	949-240-4392

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

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	03/05/2026

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