MEDICARE: MCKENZY DUFFEY LEIBOWITZ PA

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	363A00000X	Physician Assistant	PA18472	CA

General Provider Information

NPI Number	:	1457391195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENZY DUFFEY LEIBOWITZ PA

Provider Business Mailing Address
First Line	:	26516 CRENSHAW BLVD
Second Line	:
City	:	PALOS VERDES PENINSULA
State	:	CA
Zip	:	90274-3970
Country	:	US
Telephone Number	:	310-541-7911
Fax Number	:

Provider Business Practice Location Address
First Line	:	1427 MONTEREY BLVD
Second Line	:	STE 202
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-3639
Country	:	US
Telephone Number	:	310-376-1338
Fax Number	:

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

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	04/06/2015

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