Provider Demographics
NPI:1235332909
Name:ALBERT R. MACKENZIE, M.D., INC.
Entity Type:Organization
Organization Name:ALBERT R. MACKENZIE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:MACKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-789-0449
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:SUITE 520
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-789-0449
Mailing Address - Fax:818-789-1538
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 520
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-789-0449
Practice Address - Fax:818-789-1538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30192174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC30192Medicare ID - Type Unspecified
CAA34152Medicare UPIN