MACKENZIE LYNN BOLDUC (NPI# 1295243491) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295243491 |
| Entity Type | Individual |
| Full Name | MACKENZIE LYNN BOLDUC |
| Practice Address |
1964 Sheridan Rd San Bernardino CA 92407-4696 |
| Mailing Address |
565 Greenland Dr Lancaster PA 17602-5906 |
| Practice Telephone | 7609870742 |
| Mailing Telephone | 7609870742 |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2019-11-25 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
RT007068 | PA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Street Address |
1964 SHERIDAN RD |
| City | SAN BERNARDINO |
| State | CA |
| Zip Code | 92407-4696 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639789233 | Luis Enrique Macias | Case Manager/Care Coordinator | 26967 Beaumont Ave., Redlands Ca 92373, San Bernardino, CA 92407 | 2020-08-07 |
| 1619526209 | Louise E Curran | Social Worker | 6395 N Azalea Ave, San Bernardino, CA 92407 | 2019-09-06 |
| 1619496049 | Portia Monique Jackson | Licensed Vocational Nurse | 1022 Sunbrook Dr., San Bernardino, CA 92407 | 2017-09-18 |
| 1568988467 | Jon Michael Hensley | Behavior Technician | 1638 Windsor Street, San Bernardino, CA 92407 | 2017-08-22 |
| 1063933349 | Priority Rounds Transport, L.l.c | Non-emergency Medical Transport (VAN) | 18245 Evening Primrose Ln, San Bernardino, CA 92407 | 2017-06-27 |
| 1760927263 | Denkorach Inc | In Home Supportive Care | 1265 Kendall Drive, Unit 1614, San Bernardino, CA 92407 | 2016-12-20 |
| 1558606517 | Pradeep Amin | Pharmacist | 4150 N Sierra Way, San Bernardino, CA 92407 | 2012-12-03 |
| 1811231384 | Lucindy Thomasina Fuller | Rehabilitation Practitioner | 1265 Kendall Dr, San Bernardino, CA 92407 | 2012-11-21 |
| 1578793337 | Shareela Marie Allen | Social Worker | 6791 N. Ofeila Drive, San Bernardino, CA 92407 | 2009-07-15 |
| 1720239304 | Alejandro Paul Holguin | Social Worker | 6076 Norma Ln, San Bernardino, CA 92407 | 2008-10-01 |
| Find all providers in zip 92407 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922599109 | Kathryn Elizabeth Fleming | Specialist/Technologist | 1881 W Base Line St, San Bernardino, CA 92411-1650 | 2018-05-23 |
| 1881117414 | Akacia Ford | Specialist/Technologist | 1020 Pacific St, San Bernardino, CA 92404-6228 | 2017-07-25 |
| 1922521210 | Kyle A Yaross | Specialist/Technologist | 114 Plymouth Way, San Bernardino, CA 92408 | 2017-07-19 |
| 1982064572 | Zachary Norton-martinez | Specialist/Technologist | 650 Del Rosa Dr, San Bernardino, CA 92410 | 2016-02-25 |
| 1376765339 | Alicia Marleina Osuna | Specialist/Technologist | 5500 University Pkwy, San Bernardino, CA 92407-2318 | 2007-05-02 |
| 1609884246 | Guillermo Escalante | Specialist/Technologist | 5500 University Pkwy, San Bernardino, CA 92407-2318 | 2006-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003417981 | David Yudis | Specialist/Technologist | 82 Victoria Ste 201, Newport Beach, CA 92660-9009 | 2020-11-05 |
| 1790385466 | Tamia Shoshone | Specialist/Technologist | 2823 Diaz Lane, Bishop, CA 93514 | 2020-10-30 |
| 1639779630 | Taylor Anderson | Specialist/Technologist | 3320 Honolulu Ave Apt 11, La Crescenta, CA 91214-3389 | 2020-10-28 |
| 1548869571 | Joshua Watersjackson | Specialist/Technologist | 430406 Las Pulgas, Camp Pendleton, CA 92055 | 2020-10-21 |
| 1063011278 | Hilary Ann King | Specialist/Technologist | 824 W Maple Ave, Tulare, CA 93274-2609 | 2020-10-19 |
| 1568069854 | Tess Buchanan | Specialist/Technologist | 4480 Leatherwood Ct, Concord, CA 94521-4416 | 2020-10-08 |
| 1407453343 | Peter Wang | Specialist/Technologist | 3034 Belmont Dr, Lodi, CA 95242-9732 | 2020-10-05 |
| 1164029138 | Marisa Angelina Terrazas | Specialist/Technologist | 1416 Rampart Dr, Roseville, CA 95661-4749 | 2020-10-02 |
| 1427665645 | Alvaro Juarez Jr. | Specialist/Technologist | 31550 Palomar Rd, Menifee, CA 92584-9258 | 2020-09-30 |
| 1407462237 | Lorenzo Aguirre | Specialist/Technologist | 1836 Lapham Dr, Modesto, CA 95354-3900 | 2020-09-17 |
| Find all providers with the same taxonomy | ||||
| City | SAN BERNARDINO |
| Zip Code | 92407 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.