Healthcare Provider Details

I. General information

NPI: 1790535862
Provider Name (Legal Business Name): MAXWELL ALEXANDER KLINE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 SLATE AVE STE 100
RIVERSIDE CA
92505-7101
US

IV. Provider business mailing address

11725 SLATE AVE STE 100
RIVERSIDE CA
92505-7101
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-1700
  • Fax: 951-352-9117
Mailing address:
  • Phone: 951-352-1700
  • Fax: 951-352-9117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: