Provider Demographics
NPI:1992434724
Name:MAXIM HEALTHCARE
Entity type:Organization
Organization Name:MAXIM HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ZUYEIRI
Authorized Official - Last Name:MEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-830-8525
Mailing Address - Street 1:3111 CAMINO DEL RIO N STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5722
Mailing Address - Country:US
Mailing Address - Phone:619-209-3696
Mailing Address - Fax:
Practice Address - Street 1:2401 SEASIDE ST APT 308
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-1478
Practice Address - Country:US
Practice Address - Phone:619-830-8525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAXXX-XX-7056OtherMELISSA Z MEZA
CA7056OtherN/A