Provider Demographics
NPI:1578311759
Name:MAIR, MAXIMILIAN THOMAS
Entity type:Individual
Prefix:
First Name:MAXIMILIAN
Middle Name:THOMAS
Last Name:MAIR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1767 MORNING ARBOR WAY
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-7408
Mailing Address - Country:US
Mailing Address - Phone:805-813-9682
Mailing Address - Fax:
Practice Address - Street 1:1767 MORNING ARBOR WAY
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-7408
Practice Address - Country:US
Practice Address - Phone:805-813-9682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-11
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96308225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist