Provider Demographics
NPI:1376675736
Name:MAXICARE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:MAXICARE MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:SIZAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-968-8445
Mailing Address - Street 1:16000 AMAR RD
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91744-2203
Mailing Address - Country:US
Mailing Address - Phone:626-968-8445
Mailing Address - Fax:626-330-5599
Practice Address - Street 1:16000 AMAR RD
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91744-2203
Practice Address - Country:US
Practice Address - Phone:626-968-8445
Practice Address - Fax:626-330-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8164261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16711Medicare ID - Type UnspecifiedMEDICARE GROUP ID NUMBER