NPIMap

Organization Active NPI

Makini Clinic PLLC

  • Family Nurse Practitioner
  • Phoenix, AZ
National Provider Identifier
1386423176
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
MAKINI CLINIC PLLC
Practice address
8805 N 23Rd Ave Ste 100
Phoenix, AZ 85021-4172
Phone
(602) 856-6116
NPI assigned
Sep 21, 2023
Last updated
Sep 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stanley Kidiavayi, NP
Title
Owner
Phone
(602) 856-6116

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

8805 N 23Rd Ave Ste 100
Phoenix, AZ 85021-4172

Mailing address

4220 Saxton Green Ave
Las Vegas, NV 89141-4354

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240306004208 CA Part B Supplier - Clinic/Group Practice 6507211083 Receives reassigned benefits from 13 practitioners
Practice locations: Bellflower, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695254400000",
    "number": "1386423176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 SAXTON GREEN AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891414354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8805 N 23RD AVE STE 100",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850214172",
            "telephone_number": "602-856-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAKINI CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-21",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A",
        "authorized_official_last_name": "KIDIAVAYI",
        "authorized_official_first_name": "STANLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-856-6116",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.