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General NPI Number Information
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NPI Number | 1467540419
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Entity Type | Organization
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Legal Business Name | LAURINE C MAXELL, MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1777 N BELLFLOWER BLVD STE 102
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City | LONG BEACH
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State | CA
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Zip | 90815-4013
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Country | US
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Telephone | 562-498-2083
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Fax | 562-498-3165
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Provider Business Mailing Address
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Address Line | 1777 N BELLFLOWER BLVD STE 102
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City | LONG BEACH
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State | CA
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Zip | 90815-4013
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Country | US
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Telephone | 562-498-2083
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Fax | 562-498-3165
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LAURINE C MAXELL
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Credential | M.D.
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Telephone | 562-498-0832
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G71495
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License Number State | CA
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