Active NPI
Mary Jeanne Fudge, RDN
- Registered Dietitian
- San Diego, CA
National Provider Identifier
1457174120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 86377810
- Practice address
- 3538 Georgia St
San Diego, CA 92103-4618 - Phone
- (509) 656-4055
- NPI assigned
- Nov 1, 2024
- Last updated
- Nov 1, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 86377810 | CA | Primary |
Addresses
Primary practice location
3538 Georgia St
San Diego, CA 92103-4618
Mailing address
3538 Georgia St
San Diego, CA 92103-4618
Phone (509) 656-4055
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 86377810 | CA | MD | Registered Dietitian |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1730419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730419200000",
"number": "1457174120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3538 GEORGIA ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921034618",
"telephone_number": "509-656-4055"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3538 GEORGIA ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921034618",
"telephone_number": "509-656-4055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUDGE",
"first_name": "MARY",
"middle_name": "JEANNE",
"credential": "RDN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-11-01",
"last_updated": "2024-11-01",
"certification_date": "2024-11-01",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "CA",
"license": "86377810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.