Provider Demographics
NPI:1073634986
Name:MACKENZIE, BETZAIDA (MD)
Entity Type:Individual
Prefix:
First Name:BETZAIDA
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1128
Mailing Address - Street 2:
Mailing Address - City:VIEQUES
Mailing Address - State:PR
Mailing Address - Zip Code:00765-1128
Mailing Address - Country:US
Mailing Address - Phone:787-741-3476
Mailing Address - Fax:
Practice Address - Street 1:#997 ST KM 1 BO DESTINO
Practice Address - Street 2:
Practice Address - City:VIEQUES
Practice Address - State:PR
Practice Address - Zip Code:00765
Practice Address - Country:US
Practice Address - Phone:787-741-0392
Practice Address - Fax:787-741-2550
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5518208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE15324Medicare UPIN