Wyatt Blue, MS, LAT, ATC, CSCS
Individual provider Active NPI Contractor · Cardiff by the Sea, CA
NPI 1346583754 · NPPES record last updated Jan 16, 2014
Key facts
- NPI
- 1346583754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 0506246 (NV)
- Practice address
- 1732 Mackinnon Ave
Cardiff by the Sea, CA 92007-1605 - Phone
- (603) 812-6913
- NPI assigned
- Apr 3, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0506246 | NV | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 0506246 | NV | Yes |
Addresses
Primary practice location
1732 Mackinnon Ave
Cardiff by the Sea, CA 92007-1605
Mailing address
1732 Mackinnon Ave
Cardiff by the Sea, CA 92007-1605
Phone (603) 812-6913
Other providers in Cardiff by the Sea, CA
- Meghan Adamson
- Ajna Center LLC
- Cassandra Alfaro
- Edward Marcus Ayoub
- Best Performance and Physical Therapy P C
- Sage Debeixedon Breslin
- Lyndon Bruce Brown
- Hayden M Burke
- Kristin Butterfield
- C. Castro DMD, Inc
All providers in Cardiff by the Sea, CA · Contractor in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.