Healthcare Provider Details

I. General information

NPI: 1851259691
Provider Name (Legal Business Name): PATRICE HAMILTON MAKGALE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 N GRAND AVE
COVINA CA
91724-2055
US

IV. Provider business mailing address

4626 N GRAND AVE
COVINA CA
91724-2055
US

V. Phone/Fax

Practice location:
  • Phone: 626-331-5316
  • Fax:
Mailing address:
  • Phone: 626-331-5316
  • Fax: 626-331-2219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: