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General NPI Number Information
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NPI Number | 1891679080
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Entity Type | Individual
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Provider Name | MAKENA RENEE STEPHEN
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Gender | Female
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Dates
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Enumeration Date | 08/01/2025
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 6800 BROCKTON AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-3835
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Country | US
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Telephone | 951-779-1966
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Fax |
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Provider Business Mailing Address
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Address Line | 12180 RAMONA AVE
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City | CHINO
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State | CA
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Zip | 91710-2278
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Country | US
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Telephone | 951-473-6883
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 9565
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License Number State | CA
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