MEDICARE: MARY C BLUE MSCN, 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	86211451	CA

General Provider Information

NPI Number	:	1881395598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY C BLUE MSCN, RD

Provider Business Mailing Address
First Line	:	1520 E COVELL BLVD STE B5
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95616-1366
Country	:	US
Telephone Number	:	916-572-5122
Fax Number	:	530-298-2918

Provider Business Practice Location Address
First Line	:	2607 BLACKBURN DR
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95618-1542
Country	:	US
Telephone Number	:	916-572-5122
Fax Number	:	530-298-2918

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

Provider Enumeration Date	:	03/10/2023
Last Update Date	:	04/09/2026

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