Provider Demographics
NPI:1790834661
Name:GARLICK, MAX AARON
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:AARON
Last Name:GARLICK
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 1:3085 MIDDLEFIELD RD
Mailing Address - Street 2:19
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-2543
Mailing Address - Country:US
Mailing Address - Phone:650-248-5150
Mailing Address - Fax:
Practice Address - Street 1:39465 PASEO PADRE PKWY STE 2100
Practice Address - Street 2:#2100
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1624
Practice Address - Country:US
Practice Address - Phone:510-745-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program