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General NPI Number Information
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NPI Number | 1003061078
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Entity Type | Organization
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Legal Business Name | R MAKALA ANDERS MD MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 461 7TH ST W STE 3
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City | SONOMA
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State | CA
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Zip | 95476-5976
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Country | US
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Telephone | 707-938-1423
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Fax |
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Provider Business Mailing Address
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Address Line | 461 7TH ST W STE 3
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City | SONOMA
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State | CA
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Zip | 95476-5976
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Country | US
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Telephone | 707-938-1423
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. REUBEN MAKALA ANDERS
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Credential | MD
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Telephone | 707-938-1423
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | A79025
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | A79025
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | A79025
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A79025
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License Number State | CA
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