Healthcare Provider Details

I. General information

NPI: 1124687363
Provider Name (Legal Business Name): MAKENA THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 W LINNE RD STE 223
TRACY CA
95377-8004
US

IV. Provider business mailing address

1660 W LINNE RD STE 223
TRACY CA
95377-8004
US

V. Phone/Fax

Practice location:
  • Phone: 209-346-7411
  • Fax:
Mailing address:
  • Phone: 209-346-7411
  • Fax: 209-740-4494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: SARAH ROSE
Title or Position: PRESIDENT
Credential: LMFT
Phone: 209-346-7411