Provider Demographics
NPI:1447269501
Name:MCKINSTRY, M POLLY (M D)
Entity type:Individual
Prefix:
First Name:M POLLY
Middle Name:
Last Name:MCKINSTRY
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23961 CALLE DE LA MAGDALENA STE 402
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3685
Mailing Address - Country:US
Mailing Address - Phone:949-595-0095
Mailing Address - Fax:949-595-4459
Practice Address - Street 1:23961 CALLE DE LA MAGDALENA STE 402
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3685
Practice Address - Country:US
Practice Address - Phone:949-595-0095
Practice Address - Fax:949-595-4459
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54934174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist