Healthcare Provider Details

I. General information

NPI: 1437064516
Provider Name (Legal Business Name): KARLIE MACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8370 WILSHIRE BLVD STE 110
BEVERLY HILLS CA
90211-2334
US

IV. Provider business mailing address

741 N DILLON ST
LOS ANGELES CA
90026-3606
US

V. Phone/Fax

Practice location:
  • Phone: 805-722-8068
  • Fax:
Mailing address:
  • Phone: 805-722-8068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95041056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: