Healthcare Provider Details

I. General information

NPI: 1760316988
Provider Name (Legal Business Name): MAXWELL SMITH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 W MISSION AVE STE F
ESCONDIDO CA
92025-1733
US

IV. Provider business mailing address

380 STEVENS AVE STE 314
SOLANA BEACH CA
92075-2069
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-5200
  • Fax: 760-670-4243
Mailing address:
  • Phone: 858-755-5200
  • Fax: 858-755-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number310330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: