Provider Demographics
NPI:1255650594
Name:OBANA, MAKI (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAKI
Middle Name:
Last Name:OBANA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 S DOBSON RD STE 207
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-5663
Mailing Address - Country:US
Mailing Address - Phone:480-721-4880
Mailing Address - Fax:480-257-3485
Practice Address - Street 1:1845 S DOBSON RD STE 207
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5663
Practice Address - Country:US
Practice Address - Phone:480-721-4880
Practice Address - Fax:480-257-3485
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-26
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4097103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ527697Medicaid