Healthcare Provider Details

I. General information

NPI: 1235033762
Provider Name (Legal Business Name): MAXIVON HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11660 CHURCH ST APT 88
RANCHO CUCAMONGA CA
91730-8922
US

IV. Provider business mailing address

11660 CHURCH ST APT 88
RANCHO CUCAMONGA CA
91730-8922
US

V. Phone/Fax

Practice location:
  • Phone: 231-495-9198
  • Fax:
Mailing address:
  • Phone: 231-495-9198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. AJAIB SINGH
Title or Position: OWNER
Credential:
Phone: 231-495-9198