Healthcare Provider Details

I. General information

NPI: 1073522207
Provider Name (Legal Business Name): MAXINE LOUISE DEL PAINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 W VINE STREET SUITE 15
LODI CA
95240
US

IV. Provider business mailing address

PO BOX 15498
SACRAMENTO CA
95851
US

V. Phone/Fax

Practice location:
  • Phone: 209-334-4416
  • Fax: 209-371-0119
Mailing address:
  • Phone: 559-455-4000
  • Fax: 559-455-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG42341
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: