Provider Demographics
NPI:1780971366
Name:MAXX HEALTH, INC
Entity type:Organization
Organization Name:MAXX HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:561-613-4500
Mailing Address - Street 1:2500 N MILITARY TRL
Mailing Address - Street 2:SUITE #310
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6344
Mailing Address - Country:US
Mailing Address - Phone:561-613-4500
Mailing Address - Fax:561-613-4501
Practice Address - Street 1:2500 N MILITARY TRL
Practice Address - Street 2:SUITE #310
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6344
Practice Address - Country:US
Practice Address - Phone:561-613-4500
Practice Address - Fax:561-613-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87200208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFW316AOtherMEDICARE PTAN