Individual
DR. JILL DOUGAL MACKINNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2001 DWIGHT WAY, 2ND FLOOR - ROOM # 2350, BERKELEY, CA 94704-2608
(510) 204-4738
(510) 204-5892
Mailing address
2001 DWIGHT WAY, 2ND FLOOR - ROOM # 2350, BERKELEY, CA 94704-2608
(510) 204-4738
(510) 204-5892
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
Primary
G67976
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G679760
MEDI-CAL
CA
Enumeration date
10/20/2006
Last updated
07/09/2007
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