Healthcare Provider Details

I. General information

NPI: 1295415834
Provider Name (Legal Business Name): MACKENZIE ELIZABETH REAY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3628 E IMPERIAL HWY
LYNWOOD CA
90262-2643
US

IV. Provider business mailing address

3628 E IMPERIAL HWY
LYNWOOD CA
90262-2643
US

V. Phone/Fax

Practice location:
  • Phone: 310-554-4127
  • Fax:
Mailing address:
  • Phone: 310-554-4127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2028648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: