Provider Demographics
NPI:1952072357
Name:CAREY, MACKENZIE (RDN)
Entity Type:Individual
Prefix:MRS
First Name:MACKENZIE
Middle Name:
Last Name:CAREY
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDN
Mailing Address - Street 1:29402 SPA HAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-2234
Mailing Address - Country:US
Mailing Address - Phone:760-477-2301
Mailing Address - Fax:
Practice Address - Street 1:29402 SPA HAVEN WAY
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-2234
Practice Address - Country:US
Practice Address - Phone:760-477-2301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86079431133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered