Provider Demographics
NPI:1407369689
Name:MAKA, KRISTINALISA
Entity Type:Individual
Prefix:
First Name:KRISTINALISA
Middle Name:
Last Name:MAKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 41ST ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2632
Mailing Address - Country:US
Mailing Address - Phone:650-766-2367
Mailing Address - Fax:
Practice Address - Street 1:363 41ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2632
Practice Address - Country:US
Practice Address - Phone:650-766-2367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant