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Individual
MARK MAKO
Active
Individual
MARK MAKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T., O.C.S.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 15347
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0PT153470
BLUE SHIELD OF CA
CA
01
—
77057605493065A002
TRICARE
CA
01
—
PT00015347
BLUE CROSS OF CA
CA
Enumeration date
05/20/2006
Last updated
09/20/2007
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