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General NPI Number Information
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NPI Number | 1326630658
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Entity Type | Individual
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Provider Name | MACKINZIE KINDA
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Gender | Female
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 1514 E TRENTON AVE
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City | ORANGE
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State | CA
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Zip | 92867-3814
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Country | US
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Telephone | 714-854-2522
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Fax |
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Provider Business Mailing Address
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Address Line | 1514 E TRENTON AVE
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City | ORANGE
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State | CA
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Zip | 92867-3814
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 98993
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License Number State | CA
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