Healthcare Provider Details

I. General information

NPI: 1568397982
Provider Name (Legal Business Name): MAKAYLA ACZON-KAWAMURA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9474 LOGAN RIDGE CT
LAS VEGAS NV
89139-7537
US

IV. Provider business mailing address

9474 LOGAN RIDGE CT
LAS VEGAS NV
89139-7537
US

V. Phone/Fax

Practice location:
  • Phone: 808-285-4766
  • Fax:
Mailing address:
  • Phone: 808-285-4766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number897160
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: