MEDICARE: MS. KARLOTTA MAE MCKENZIE P.A.

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	363AM0700X	Medical Physician Assistant	PA 10535	CA

General Provider Information

NPI Number	:	1841230851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARLOTTA MAE MCKENZIE P.A.

Provider Business Mailing Address
First Line	:	PO BOX 8310
Second Line	:
City	:	INGLEWOOD
State	:	CA
Zip	:	90308-8310
Country	:	US
Telephone Number	:	323-778-6600
Fax Number	:	323-778-6691

Provider Business Practice Location Address
First Line	:	2500 W FLORENCE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90043-5144
Country	:	US
Telephone Number	:	323-778-6600
Fax Number	:	323-778-6691

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	06/09/2011

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