Individual
EDWARD MAXWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2250 HAYES ST, STE 302, SAN FRANCISCO, CA 94117
(415) 750-5995
(415) 666-3144
Mailing address
2250 HAYES ST, STE 302, SAN FRANCISCO, CA 94117
(415) 750-5995
(415) 666-3144
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
A 109141
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A109141
MEDICAL LICENSE#
CA
01
—
FHC 70042F
SANTA CRUZ COUNTY MEDI-CAL PROVIDER #
CA
01
—
ZZZ92069Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
Enumeration date
08/13/2009
Last updated
03/07/2023
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