Individual
LARRY MAXWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4445 BURNS AVE, LOS ANGELES, CA 90029-2702
(323) 664-8940
Mailing address
4445 BURNS AVE, LOS ANGELES, CA 90029
(323) 664-8940
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
R1236821116
CA
Other
Enumeration date
02/06/2017
Last updated
02/06/2017
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