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General NPI Number Information
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NPI Number | 1265115364
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Entity Type | Organization
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Legal Business Name | MAYNARD FIRM LLC
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 3680 WILSHIRE BLVD # P04-1025
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City | LOS ANGELES
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State | CA
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Zip | 90010-2707
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Country | US
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Telephone | 323-633-9766
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Fax |
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Provider Business Mailing Address
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Address Line | 3680 WILSHIRE BLVD # P04-1025
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City | LOS ANGELES
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State | CA
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Zip | 90010-2707
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Country | US
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Telephone | 323-633-9766
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. NEVON MAURICE WATSON
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Credential |
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Telephone | 323-633-9766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QF0050X
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Taxonomy Name | Non-Surgical Family Planning Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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