Healthcare Provider Details

I. General information

NPI: 1790523728
Provider Name (Legal Business Name): NADIYA MCKENZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 WILLOW PASS RD STE 207
CONCORD CA
94520-2542
US

IV. Provider business mailing address

24077 STATE HIGHWAY 49
NEVADA CITY CA
95959-8519
US

V. Phone/Fax

Practice location:
  • Phone: 530-292-3450
  • Fax:
Mailing address:
  • Phone: 530-292-3803
  • Fax: 530-292-3803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: