Basic Information
Provider Information | |||||||||
NPI: | 1184937047 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MAKANUI | ||||||||
FirstName: | PAUL | ||||||||
MiddleName: | KALANI | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PH. D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MAKANUI | ||||||||
OtherFirstName: | KALANI | ||||||||
OtherMiddleName: | PAUL | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PH. D. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 4760 SEPULVEDA BLVD | ||||||||
Address2: |   | ||||||||
City: | CULVER CITY | ||||||||
State: | CA | ||||||||
PostalCode: | 902304820 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3103906612 | ||||||||
FaxNumber: | 3103985690 | ||||||||
Practice Location | |||||||||
Address1: | 323 N PRAIRIE AVE | ||||||||
Address2: |   | ||||||||
City: | INGLEWOOD | ||||||||
State: | CA | ||||||||
PostalCode: | 903014502 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3108462100 | ||||||||
FaxNumber: | 3108462139 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/21/2010 | ||||||||
LastUpdateDate: | 05/09/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY26346 | CA | Y |   | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.