Provider Demographics
NPI:1285423210
Name:GOLDMAN, MAXWELL (CMT)
Entity type:Individual
Prefix:MR
First Name:MAXWELL
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 S HOLT AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1844
Mailing Address - Country:US
Mailing Address - Phone:510-220-0661
Mailing Address - Fax:
Practice Address - Street 1:844 S HOLT AVE APT 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1844
Practice Address - Country:US
Practice Address - Phone:510-220-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79405225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist