Provider Demographics
NPI:1508090887
Name:MACKENZIE, TENESSA MORGAN (MD)
Entity Type:Individual
Prefix:
First Name:TENESSA
Middle Name:MORGAN
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1569 SLOAT BLVD
Mailing Address - Street 2:SUITE 333
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-1256
Mailing Address - Country:US
Mailing Address - Phone:415-353-9339
Mailing Address - Fax:415-353-3450
Practice Address - Street 1:1569 SLOAT BLVD
Practice Address - Street 2:SUITE 333
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1256
Practice Address - Country:US
Practice Address - Phone:415-353-9339
Practice Address - Fax:415-353-3450
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-14
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA128292207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine