Provider Demographics
NPI:1659305829
Name:MAKENA MEDICAL, INC.
Entity Type:Organization
Organization Name:MAKENA MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SCHUERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-716-9801
Mailing Address - Street 1:2400 PULLMAN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5509
Mailing Address - Country:US
Mailing Address - Phone:949-716-9801
Mailing Address - Fax:949-716-9802
Practice Address - Street 1:2400 PULLMAN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5509
Practice Address - Country:US
Practice Address - Phone:949-716-9801
Practice Address - Fax:949-716-9802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44389332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5507940001Medicare NSC