Healthcare Provider Details

I. General information

NPI: 1982184669
Provider Name (Legal Business Name): MAXIMILLIAN ISRAEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28212 KELLY JOHNSON PKWY STE 200
VALENCIA CA
91355-5090
US

IV. Provider business mailing address

28212 KELLY JOHNSON PKWY STE 200
VALENCIA CA
91355-5090
US

V. Phone/Fax

Practice location:
  • Phone: 213-228-3538
  • Fax:
Mailing address:
  • Phone: 213-228-3538
  • Fax:

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: