Provider Demographics
NPI:1841230851
Name:MCKENZIE, KARLOTTA MAE (PA)
Entity Type:Individual
Prefix:MS
First Name:KARLOTTA
Middle Name:MAE
Last Name:MCKENZIE
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 8310
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90308-8310
Mailing Address - Country:US
Mailing Address - Phone:323-778-6600
Mailing Address - Fax:323-778-6691
Practice Address - Street 1:2500 W FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-5144
Practice Address - Country:US
Practice Address - Phone:323-778-6600
Practice Address - Fax:323-778-6691
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA 10535363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ 08451Medicare UPIN