Individual
DR. RANDALL WHITAKER MAXEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
447 N PRAIRIE AVE, INGLEWOOD, CA 90301-1413
(310) 680-1810
(310) 680-1811
Mailing address
PO BOX 83246, LOS ANGELES, CA 90083-0246
(310) 680-1810
(310) 680-1811
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
C38014
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C380140
—
CA
Enumeration date
12/05/2006
Last updated
09/26/2019
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