Provider Demographics
NPI:1881309029
Name:MAKIWARA, INC
Entity type:Organization
Organization Name:MAKIWARA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-464-0369
Mailing Address - Street 1:4180 SW 74TH CT STE 204
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4443
Mailing Address - Country:US
Mailing Address - Phone:786-587-4190
Mailing Address - Fax:
Practice Address - Street 1:4180 SW 74TH CT STE 204
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4443
Practice Address - Country:US
Practice Address - Phone:786-587-4190
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care