Basic Information
| Provider Information | |||||||||
| NPI: | 1255650594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OBANA | ||||||||
| FirstName: | MAKI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 W CHANDLER BLVD STE 15-212 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852246211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807214880 | ||||||||
| FaxNumber: | 4802642763 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 N DOBSON RD STE D-3 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852249610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807214880 | ||||||||
| FaxNumber: | 4802642763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2010 | ||||||||
| LastUpdateDate: | 07/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 4097 | AZ | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.