MEDICARE: JANEL MCKAY CMT

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	171W00000X	Contractor	41477	CA

General Provider Information

NPI Number	:	1538584404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANEL MCKAY CMT

Provider Business Mailing Address
First Line	:	9228 RONDA AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-3515
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3026 N PARK WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-3626
Country	:	US
Telephone Number	:	619-333-8733
Fax Number	:

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

Provider Enumeration Date	:	02/28/2014
Last Update Date	:	02/28/2014

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