MEDICARE: SHERRI L. MAXIMIUK PA

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
1	363AM0700X	Medical Physician Assistant	PA16079	CA

General Provider Information

NPI Number	:	1700936010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRI L. MAXIMIUK PA

Provider Business Mailing Address
First Line	:	2865 ATLANTIC AVE STE 226
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1723
Country	:	US
Telephone Number	:	714-926-8444
Fax Number	:	714-738-1352

Provider Business Practice Location Address
First Line	:	2865 ATLANTIC AVE STE 226
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1723
Country	:	US
Telephone Number	:	714-926-8444
Fax Number	:	714-738-1352

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	03/18/2022

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