Provider Demographics
NPI:1467529479
Name:RAYNES MAHONY, LINDA ANN (MSRD CDE)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ANN
Last Name:RAYNES MAHONY
Suffix:
Gender:F
Credentials:MSRD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6986 CAMINO REVUELTOS
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-7642
Mailing Address - Country:US
Mailing Address - Phone:858-565-2205
Mailing Address - Fax:619-296-1852
Practice Address - Street 1:3500 5TH AVE STE 301
Practice Address - Street 2:U.C.S.D. CENTER FOR TRANSPLANTATION
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5020
Practice Address - Country:US
Practice Address - Phone:619-574-8612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
370262133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic