Provider Demographics
NPI:1770110645
Name:RINALDI, MACKENZIE CLAIRE (MD)
Entity type:Individual
Prefix:
First Name:MACKENZIE
Middle Name:CLAIRE
Last Name:RINALDI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:MACKENZIE
Other - Middle Name:CLAIRE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1205 SE PROFESSIONAL MALL BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5423
Mailing Address - Country:US
Mailing Address - Phone:509-332-2605
Mailing Address - Fax:509-715-2123
Practice Address - Street 1:1205 SE PROFESSIONAL MALL BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5423
Practice Address - Country:US
Practice Address - Phone:509-332-2605
Practice Address - Fax:509-715-2123
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM17298208000000X
WAMD61423154208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2257556Medicaid