Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013551795 |
---|---|
Provider Name | Sarah Mckenzie |
First Address | San Leandro, CA 94578-1132 |
Second Address | San Leandro, CA 94578-1132 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2019 |
Last Update Date | 12/11/2019 |