Healthcare Provider Details

I. General information

NPI: 1720281439
Provider Name (Legal Business Name): MAXINE ELOIS LIGGINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 E 102ND ST ROOM 142
LOS ANGELES CA
90002-3338
US

IV. Provider business mailing address

1522 E 102ND ST ROOM 142
LOS ANGELES CA
90002-3338
US

V. Phone/Fax

Practice location:
  • Phone: 323-563-4062
  • Fax: 323-249-1594
Mailing address:
  • Phone: 323-563-4062
  • Fax: 323-249-1594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberG59227
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG59227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: