Provider Demographics
NPI:1114432101
Name:CYPHER, MACKENZIE MAY
Entity Type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:MAY
Last Name:CYPHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 CORNERSTONE CT E STE 220
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-4737
Mailing Address - Country:US
Mailing Address - Phone:858-458-2992
Mailing Address - Fax:858-458-3655
Practice Address - Street 1:6155 CORNERSTONE CT E STE 220
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-4737
Practice Address - Country:US
Practice Address - Phone:858-458-2992
Practice Address - Fax:858-458-3655
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007594363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner