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General NPI Number Information
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NPI Number | 1619811056
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Entity Type | Organization
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Legal Business Name | MAC INNOVATION
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Dates
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Enumeration Date | 04/16/2026
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Last Update Date | 04/16/2026
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Provider Practice Location Address
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Address Line | 1460 S MCCALL RD STE 1A
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City | ENGLEWOOD
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State | FL
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Zip | 34223-4824
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Country | US
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Telephone | 520-904-5035
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Fax |
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Provider Business Mailing Address
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Address Line | 1460 S MCCALL RD
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City | ENGLEWOOD
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State | FL
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Zip | 34223-4864
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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 | CEO
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Name | MRS. CASSANDRA SYLVIA YOUNG
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Credential |
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Telephone | 520-904-5035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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