Basic Information
| Provider Information | |||||||||
| NPI: | 1326017690 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MACKEY | ||||||||
| FirstName: | ERNEST | ||||||||
| MiddleName: | DANIEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MACKEY | ||||||||
| OtherFirstName: | DANIEL | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13132 NEWPORT AVE | ||||||||
| Address2: | 100 | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927803429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145657960 | ||||||||
| FaxNumber: | 7145657982 | ||||||||
| Practice Location | |||||||||
| Address1: | 13132 NEWPORT AVE | ||||||||
| Address2: | 100 | ||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927803429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145657960 | ||||||||
| FaxNumber: | 7145657982 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2006 | ||||||||
| LastUpdateDate: | 01/04/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A61274 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080A0000X | A61274 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No ID Information.