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NPI Code Detail

MEDICARE: DEANDRE A. MAXWELL

MEDICARE: DEANDRE A. MAXWELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorC051620318CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1101076OTHERCADRUG MEDI-CAL

General Provider Information

NPI Number : 1407982713
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEANDRE A. MAXWELL
Provider Business Mailing Address
First Line : 481 N ORANGEWOOD AVE
Second Line :
City : FRESNO
State : CA
Zip : 93727-3230
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1310 M ST
Second Line :
City : FRESNO
State : CA
Zip : 93721-1808
Country : US
Telephone Number : 559-264-2700
Fax Number : 559-264-2767
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2007
Last Update Date : 09/10/2024

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Directions to “ DEANDRE A. MAXWELL ” Practice Location

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