MEDICARE: ALIYAH MCKINZE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-24-326136	CA

General Provider Information

NPI Number	:	1114777851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALIYAH MCKINZE

Provider Business Mailing Address
First Line	:	1204 DENVER LN UNIT A
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92021-4778
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1204 DENVER LN UNIT A
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92021-4778
Country	:	US
Telephone Number	:	619-251-8904
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2024
Last Update Date	:	03/25/2024

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