Healthcare Provider Details

I. General information

NPI: 1821933227
Provider Name (Legal Business Name): MACKENZIE POTTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15632 POMERADO RD
POWAY CA
92064-2406
US

IV. Provider business mailing address

649 OLD HIGHWAY 8 NW
NEW BRIGHTON MN
55112-2788
US

V. Phone/Fax

Practice location:
  • Phone: 858-485-5153
  • Fax:
Mailing address:
  • Phone: 651-278-7387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number7412
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: