Provider Demographics
NPI:1154749562
Name:BABAZADEH, MAXINE KAY (MPT)
Entity type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:KAY
Last Name:BABAZADEH
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4206
Mailing Address - Country:US
Mailing Address - Phone:310-621-6225
Mailing Address - Fax:
Practice Address - Street 1:3205 CLAY ST
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4206
Practice Address - Country:US
Practice Address - Phone:310-621-6225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist