Provider Demographics
NPI:1588038947
Name:MAKEN, DR DEBORAH (ND)
Entity Type:Individual
Prefix:
First Name:DR DEBORAH
Middle Name:
Last Name:MAKEN
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2002 4TH ST APT 212
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1134
Mailing Address - Country:US
Mailing Address - Phone:937-684-0112
Mailing Address - Fax:
Practice Address - Street 1:2002 4TH ST APT 212
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1134
Practice Address - Country:US
Practice Address - Phone:937-684-0112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND765175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath