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General NPI Number Information
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NPI Number | 1114150877
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Entity Type | Individual
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Provider Name | LYDIA MACKEOGH
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Gender | Female
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Dates
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Enumeration Date | 08/28/2009
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Last Update Date | 08/28/2009
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Provider Practice Location Address
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Address Line | 66 HURLBUT STREET PACIFIC CLINICS
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City | PASADENA
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State | CA
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Zip | 91105
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Country | US
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Telephone | 626-441-4221
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Fax |
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Provider Business Mailing Address
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Address Line | 1127 E DEL MAR BLVD APT 317
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City | PASADENA
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State | CA
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Zip | 91106-3438
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Country | US
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Telephone | 626-818-6326
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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 | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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