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General NPI Number Information
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NPI Number | 1104530401
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Entity Type | Individual
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Provider Name | KERIANNE MCKENZIE
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Gender | Female
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 2067 W VISTA WAY STE 250
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City | VISTA
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State | CA
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Zip | 92083-6034
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Country | US
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Telephone | 951-852-6334
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Fax |
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Provider Business Mailing Address
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Address Line | 9835 JAKE LN APT 11404
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City | SAN DIEGO
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State | CA
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Zip | 92126-2972
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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