Provider Demographics
NPI:1780658849
Name:MAKELA, SANDRA L (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:MAKELA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2865 ATLANTIC AVENUE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806
Mailing Address - Country:US
Mailing Address - Phone:562-595-7709
Mailing Address - Fax:562-595-5720
Practice Address - Street 1:2865 ATLANTIC AVENUE
Practice Address - Street 2:SUITE 250
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806
Practice Address - Country:US
Practice Address - Phone:562-595-7709
Practice Address - Fax:562-595-5720
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82346207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F65561Medicare UPIN
G82346Medicare ID - Type Unspecified