Healthcare Provider Details

I. General information

NPI: 1841230851
Provider Name (Legal Business Name): KARLOTTA MAE MCKENZIE P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W FLORENCE AVE
LOS ANGELES CA
90043-5144
US

IV. Provider business mailing address

PO BOX 8310
INGLEWOOD CA
90308-8310
US

V. Phone/Fax

Practice location:
  • Phone: 323-778-6600
  • Fax: 323-778-6691
Mailing address:
  • Phone: 323-778-6600
  • Fax: 323-778-6691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 10535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: