Provider Demographics
NPI:1962530063
Name:MACKENZIE, JOAN H (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:H
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:JOAN
Other - Middle Name:L
Other - Last Name:HILLSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2850 ARTESIA BLVD
Mailing Address - Street 2:SUITE 209 JOAN H MACKENZIE MD
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3413
Mailing Address - Country:US
Mailing Address - Phone:310-542-8946
Mailing Address - Fax:310-375-6732
Practice Address - Street 1:2850 ARTESIA BLVD
Practice Address - Street 2:SUITE 209 JOAN H MACKENZIE MD
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-3413
Practice Address - Country:US
Practice Address - Phone:310-542-8946
Practice Address - Fax:310-375-6732
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G1215302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G121530Medicaid
B50893Medicare UPIN
CA00G121530Medicare ID - Type Unspecified