Provider Demographics
NPI:1063519932
Name:DIAMOND, MAXIMO CHRISTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:MAXIMO
Middle Name:CHRISTIAN
Last Name:DIAMOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MAX
Other - Middle Name:
Other - Last Name:DIAMOND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4140
Mailing Address - Street 2:
Mailing Address - City:MONARCH BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92629
Mailing Address - Country:US
Mailing Address - Phone:714-221-5182
Mailing Address - Fax:714-244-4533
Practice Address - Street 1:600 CITY PARKWAY WEST
Practice Address - Street 2:SUITE 400
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2900
Practice Address - Country:US
Practice Address - Phone:714-221-5182
Practice Address - Fax:714-244-4533
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74989207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF92807Medicare UPIN