Healthcare Provider Details

I. General information

NPI: 1699681122
Provider Name (Legal Business Name): MAX MIXON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5315 TORRANCE BLVD # B1
TORRANCE CA
90503-4011
US

IV. Provider business mailing address

4389 ELM AVE
LONG BEACH CA
90807-2101
US

V. Phone/Fax

Practice location:
  • Phone: 800-829-8660
  • Fax:
Mailing address:
  • Phone: 916-316-0824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95041188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: