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NPI Code Detail

MEDICARE: MACKENZIE MARTIN

MEDICARE: MACKENZIE MARTIN
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1871052936
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACKENZIE MARTIN
Provider Business Mailing Address
First Line : 18685 MAIN ST STE 101-459
Second Line :
City : HUNTINGTON BEACH
State : CA
Zip : 92648-1723
Country : US
Telephone Number : 714-697-1907
Fax Number :
Provider Business Practice Location Address
First Line : 3056 MILES JOHNSON PKWY
Second Line :
City : SPRING HILL
State : TN
Zip : 37174-4564
Country : US
Telephone Number : 877-407-3422
Fax Number : 877-407-4329
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2019
Last Update Date : 05/09/2025

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Directions to “ MACKENZIE MARTIN ” Practice Location

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