Healthcare Provider Details

I. General information

NPI: 1063328532
Provider Name (Legal Business Name): MRS. MACKENZYE GAMEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E JOHN CARPENTER FWY STE 250
IRVING TX
75062-3972
US

IV. Provider business mailing address

2526 MANANA DR STE 208
DALLAS TX
75220-1242
US

V. Phone/Fax

Practice location:
  • Phone: 469-248-6678
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: