Provider Demographics
NPI:1467540419
Name:LAURINE C MAXELL, MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:LAURINE C MAXELL, MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAXELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-498-0832
Mailing Address - Street 1:1777 N BELLFLOWER BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-4013
Mailing Address - Country:US
Mailing Address - Phone:562-498-2083
Mailing Address - Fax:562-498-3165
Practice Address - Street 1:1777 N BELLFLOWER BLVD
Practice Address - Street 2:STE 102
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-4013
Practice Address - Country:US
Practice Address - Phone:562-498-2083
Practice Address - Fax:562-498-3165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71495207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG71495Medicare ID - Type Unspecified
CAF3638Medicare UPIN