Provider Demographics
NPI:1043102833
Name:SKINNER, MAX L
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:L
Last Name:SKINNER
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 1:1254 WHITECLIFF RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5146
Mailing Address - Country:US
Mailing Address - Phone:818-262-2054
Mailing Address - Fax:
Practice Address - Street 1:1254 WHITECLIFF RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5146
Practice Address - Country:US
Practice Address - Phone:818-262-2054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula