Healthcare Provider Details

I. General information

NPI: 1740085307
Provider Name (Legal Business Name): GEORGE MCKENZIE-DAJIC PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2025
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7543 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-6406
US

IV. Provider business mailing address

7543 SANTA MONICA BLVD
WEST HOLLYWOOD CA
90046-6406
US

V. Phone/Fax

Practice location:
  • Phone: 323-988-5900
  • Fax:
Mailing address:
  • Phone: 323-988-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP95034493
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406701
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: