Provider Demographics
NPI:1558468637
Name:MC CANN, MELANIE TRACY (RD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:TRACY
Last Name:MC CANN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5030 OFFICE PARK DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:90039-0612
Mailing Address - Country:US
Mailing Address - Phone:661-323-2847
Mailing Address - Fax:661-323-0566
Practice Address - Street 1:5030 OFFICE PARK DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0612
Practice Address - Country:US
Practice Address - Phone:661-323-2847
Practice Address - Fax:661-323-0566
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA520252133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
520252OtherCDR
520252OtherCDR