1780005306 NPI number — DANIEL & MAX

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780005306 NPI number — DANIEL & MAX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL & MAX
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780005306
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1615 S CONGRESS AVE STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33445-6326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-208-8464
Provider Business Mailing Address Fax Number:
561-275-2030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8889 GATEWAY BLVD W
Provider Second Line Business Practice Location Address:
SUITE 1010
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79925-6537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-206-2766
Provider Business Practice Location Address Fax Number:
561-828-8367
Provider Enumeration Date:
12/27/2013

Additional Information

Authorized Official

Authorized Official Last Name:
CANTRELL
Authorized Official First Name:
KIRSTEN
Authorized Official Middle Name:
PIPHER
Authorized Official Title or Position:
MANAGER OF HEALTH SERVICES
Authorized Official Telephone Number:
561-208-8464

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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