MEDICARE: DR. MEHBOOB ALI MAKHANI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A64828	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386610988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEHBOOB ALI MAKHANI M.D.

Provider Business Mailing Address
First Line	:	20211 VIA MEDICI
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-4059
Country	:	US
Telephone Number	:	818-717-8464
Fax Number	:	818-530-7880

Provider Business Practice Location Address
First Line	:	17075 DEVONSHIRE ST
Second Line	:	SUITE 204
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-1600
Country	:	US
Telephone Number	:	818-717-8464
Fax Number	:	818-530-7880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	02/24/2017

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