Individual
MAX SHAWN DOYLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13566 GILMORE ST, VAN NUYS, CA 91401-1705
(818) 203-8123
Mailing address
13566 GILMORE ST, VAN NUYS, CA 91401-1705
(818) 203-8123
Taxonomy
Speciality
Code
Description
License number
State
103TM1800X
Intellectual & Developmental Disabilities Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
XDPCA8011110
ANTHEM
—
Enumeration date
07/29/2022
Last updated
07/29/2022
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