MEDICARE: JANE SYLVIA MAKI LMFT

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	106H00000X	Marriage & Family Therapist	M14786	CA

General Provider Information

NPI Number	:	1467746081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANE SYLVIA MAKI LMFT

Provider Business Mailing Address
First Line	:	6906 PACIFIC VIEW DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-2036
Country	:	US
Telephone Number	:	323-874-7937
Fax Number	:

Provider Business Practice Location Address
First Line	:	6906 PACIFIC VIEW DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90068-2036
Country	:	US
Telephone Number	:	323-874-7937
Fax Number	:

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

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	09/06/2011

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