Provider Demographics
NPI:1104823814
Name:MCKENZIE, RICARDO ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:ENRIQUE
Last Name:MCKENZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6815
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-6815
Mailing Address - Country:US
Mailing Address - Phone:310-604-3456
Mailing Address - Fax:949-249-0665
Practice Address - Street 1:3680 E IMPERIAL HWY
Practice Address - Street 2:SUITE 470
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-2659
Practice Address - Country:US
Practice Address - Phone:310-604-3456
Practice Address - Fax:310-762-6442
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA43601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine