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General NPI Number Information
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NPI Number | 1487347183
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Entity Type | Organization
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Legal Business Name | MAXLIFE MEDICAL GROUP INC
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 11161 WASHINGTON BLVD
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City | WHITTIER
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State | CA
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Zip | 90606-3007
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Country | US
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Telephone | 562-800-0603
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Fax | 562-800-0605
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Provider Business Mailing Address
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Address Line | 11161 WASHINGTON BLVD
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City | WHITTIER
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State | CA
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Zip | 90606-3007
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Country | US
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Telephone | 562-800-0603
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Fax | 562-800-0605
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Authorized Official
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Title or Position | MANAGER
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Name | SAM JEFFERY
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Credential |
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Telephone | 562-800-0603
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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