Healthcare Provider Details

I. General information

NPI: 1770144909
Provider Name (Legal Business Name): RICHIKA MAKOL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 MOORPARK AVE
SAN JOSE CA
95117-1840
US

IV. Provider business mailing address

4050 MOORPARK AVE
SAN JOSE CA
95117-1840
US

V. Phone/Fax

Practice location:
  • Phone: 408-243-2700
  • Fax:
Mailing address:
  • Phone: 408-243-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberA196726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: