Healthcare Provider Details

I. General information

NPI: 1477235273
Provider Name (Legal Business Name): ALLISON I MACKENZIE CMT, CHT, NLP, TLTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 08/02/2023
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 CALIFORNIA ST
EL SEGUNDO CA
90245-4309
US

IV. Provider business mailing address

856 VIRGINIA ST
EL SEGUNDO CA
90245-2150
US

V. Phone/Fax

Practice location:
  • Phone: 424-405-6411
  • Fax:
Mailing address:
  • Phone: 310-600-4677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number43694
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberH38358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: