Provider Demographics
NPI:1083367627
Name:BROWN, MCKENZIE (RD)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10245 CIRCA VALLE VERDE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-2218
Mailing Address - Country:US
Mailing Address - Phone:254-495-7064
Mailing Address - Fax:
Practice Address - Street 1:10245 CIRCA VALLE VERDE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-2218
Practice Address - Country:US
Practice Address - Phone:254-495-7064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered