Organization
MAKINI CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STANLEY KIDIAVAYI NP (OWNER)
(602) 856-6116
Entity
Organization
Contact information
Practice address
8805 N 23RD AVE STE 100, PHOENIX, AZ 85021-4172
(602) 856-6116
Mailing address
4220 SAXTON GREEN AVE, LAS VEGAS, NV 89141-4354
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/21/2023
Last updated
09/21/2023
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