Provider Demographics
NPI:1538352745
Name:KAREN M MACKENZIE, M.D., INC
Entity type:Organization
Organization Name:KAREN M MACKENZIE, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-733-9900
Mailing Address - Street 1:316 W ACEQUIA AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-6232
Mailing Address - Country:US
Mailing Address - Phone:559-733-9900
Mailing Address - Fax:559-733-9903
Practice Address - Street 1:316 W ACEQUIA AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-6232
Practice Address - Country:US
Practice Address - Phone:559-733-9900
Practice Address - Fax:559-733-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85141174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty