Healthcare Provider Details

I. General information

NPI: 1578635330
Provider Name (Legal Business Name): LAURINE C MAXELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 10/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5977 E. SPRING ST
LONG BEACH CA
90808
US

IV. Provider business mailing address

11 TECHNOLOGY DR
IRVINE CA
92618-2302
US

V. Phone/Fax

Practice location:
  • Phone: 562-421-3727
  • Fax: 562-420-8948
Mailing address:
  • Phone: 949-923-3277
  • Fax: 855-812-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG71495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: