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NPI Code Detail

MEDICARE: MR. NORMAN MACKENZIE III SUDCC-II

MEDICARE: MR. NORMAN MACKENZIE III SUDCC-II
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
1171M00000XCase Manager/Care Coordinator10042CA
2101YA0400XAddiction (Substance Use Disorder) Counselor10042CA

General Provider Information

NPI Number : 1902350077
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NORMAN MACKENZIE III SUDCC-II
Provider Business Mailing Address
First Line : 1501 IMPERIAL AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-7638
Country : US
Telephone Number : 619-233-8500
Fax Number :
Provider Business Practice Location Address
First Line : 1501 IMPERIAL AVE
Second Line :
City : SAN DIEGO
State : CA
Zip : 92101-7638
Country : US
Telephone Number : 619-233-8500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2016
Last Update Date : 03/12/2026

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