Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A100302 | CA |
N | 208600000X | Surgeon | A100302 | CA |
N | 208200000X | Surgeon | MD068018L | PA |
N | 208600000X | Surgeon | MD068018L | PA |
Y | 2086S0120X | Pediatric Surgery | A100302 | CA |
NPI | 1437247426 |
---|---|
Provider Name | Dr. Tippi C Mackenzie |
First Address | San Francisco, CA 94143-2202 |
Second Address | San Francisco, CA 94143-2202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 17/03/2018 |