Provider Demographics
NPI:1417415712
Name:NEAL, MCKENZIE MARIE
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:MARIE
Last Name:NEAL
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 1:28520 FARRIER DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91354-4502
Mailing Address - Country:US
Mailing Address - Phone:404-895-9923
Mailing Address - Fax:
Practice Address - Street 1:28520 FARRIER DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91354-4502
Practice Address - Country:US
Practice Address - Phone:404-895-9923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program