Basic Information
| Provider Information | |||||||||
| NPI: | 1811436967 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAKINDE | ||||||||
| FirstName: | AKINWUNMI | ||||||||
| MiddleName: | KOLADE | ||||||||
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| OtherLastName: | MAKINDE | ||||||||
| OtherFirstName: | KOLADE | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 200 PORTER DR STE 215 | ||||||||
| Address2: | |||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945831524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253622167 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3300 WEBSTER ST STE 1201 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105498050 | ||||||||
| FaxNumber: | 5104862333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2017 | ||||||||
| LastUpdateDate: | 01/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 292865 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.