Provider Demographics
NPI:1407582604
Name:DOYLE, MAX SHAWN
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:SHAWN
Last Name:DOYLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13566 GILMORE ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1705
Mailing Address - Country:US
Mailing Address - Phone:818-203-8123
Mailing Address - Fax:
Practice Address - Street 1:13566 GILMORE ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1705
Practice Address - Country:US
Practice Address - Phone:818-203-8123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
XDPCA8011110OtherANTHEM