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General NPI Number Information
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NPI Number | 1003467879
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Entity Type | Individual
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Provider Name | SUNNY MAKOLO
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Gender | Male
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 08/24/2026
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Provider Practice Location Address
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Address Line | 1225 W 190TH ST STE 280
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City | GARDENA
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State | CA
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Zip | 90248-4305
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Country | US
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Telephone | 877-515-8113
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 W UNION HILLS DR
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City | PHOENIX
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State | AZ
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Zip | 85027-5163
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 250872
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 844501
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License Number State | TX
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