Healthcare Provider Details

I. General information

NPI: 1235729757
Provider Name (Legal Business Name): MAKAI DEVIN WRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8140 SUNLAND BLVD
SUN VALLEY CA
91352-3948
US

IV. Provider business mailing address

432 E SPRUCE AVE UNIT 83
INGLEWOOD CA
90301-6344
US

V. Phone/Fax

Practice location:
  • Phone: 818-582-8832
  • Fax: 818-582-8836
Mailing address:
  • Phone: 310-753-6017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: