Basic Information
| Provider Information | |||||||||
| NPI: | 1164847133 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEXT MOVE ANENCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14717 HAWTHORNE BLVD | ||||||||
| Address2: | #B | ||||||||
| City: | LAWNDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902601549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105530432 | ||||||||
| FaxNumber: | 2134022101 | ||||||||
| Practice Location | |||||||||
| Address1: | 11270 EXPOSITION BLVD | ||||||||
| Address2: | #642931 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900645903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105530432 | ||||||||
| FaxNumber: | 2134022101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2014 | ||||||||
| LastUpdateDate: | 02/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | MAKOUIE | ||||||||
| AuthorizedOfficialFirstName: | BAHBAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3105530432 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | MFC 52448 | CA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1437468782 | 01 | CA | NPI | OTHER |