Active NPI
Mackenzie Hall, DACM
- Acupuncturist
- Corte Madera, CA
National Provider Identifier
1710617220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 19472
- Practice address
- 21 Tamal Vista Blvd Ste 219
Corte Madera, CA 94925-1147 - Phone
- (415) 968-9294
- NPI assigned
- Jun 16, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 19472 | CA | Primary |
Addresses
Primary practice location
21 Tamal Vista Blvd Ste 219
Corte Madera, CA 94925-1147
Mailing address
629 Cascade Dr
Fairfax, CA 94930-2212
Phone (617) 240-1117
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19472 | CA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655337600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655337600000",
"number": "1710617220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "629 CASCADE DR",
"city": "FAIRFAX",
"state": "CA",
"postal_code": "949302212",
"telephone_number": "617-240-1117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 TAMAL VISTA BLVD STE 219",
"city": "CORTE MADERA",
"state": "CA",
"postal_code": "949251147",
"telephone_number": "415-968-9294"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALL",
"first_name": "MACKENZIE",
"credential": "DACM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-06-16",
"last_updated": "2022-06-16",
"certification_date": "2022-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "CA",
"license": "19472",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Corte Madera, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.