Provider Demographics
NPI:1326352857
Name:MAXIMED, INC.
Entity Type:Organization
Organization Name:MAXIMED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:TCHAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-264-2800
Mailing Address - Street 1:320 GOLDEN SHR
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4243
Mailing Address - Country:US
Mailing Address - Phone:562-264-2800
Mailing Address - Fax:562-264-2558
Practice Address - Street 1:320 GOLDEN SHR
Practice Address - Street 2:SUITE # 200
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4243
Practice Address - Country:US
Practice Address - Phone:562-264-2800
Practice Address - Fax:562-264-2558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAM3428OtherHEALTH NET