Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | R1344090419 | CA |
NPI | 1003483967 |
---|---|
Provider Name | Mr. Makoa Hecita |
First Address | Santa Ana, CA 92705-4007 |
Second Address | Santa Ana, CA 92705-4007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2021 |
Last Update Date | 03/08/2021 |