1831938109 NPI number — DANIEL MAX & MARC ANDREA LLC

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 1831938109 NPI number — DANIEL MAX & MARC ANDREA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANIEL MAX & MARC ANDREA LLC
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:
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:
1831938109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/24/2024
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:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2470 PEARLAND PKWY
Provider Second Line Business Practice Location Address:
SUITE 160
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
346-358-4220
Provider Business Practice Location Address Fax Number:
346-358-4223
Provider Enumeration Date:
05/24/2024

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)