Provider Demographics
NPI:1801100839
Name:MAXIMA THERAPY AND SPEECH CLINIC, INC.
Entity type:Organization
Organization Name:MAXIMA THERAPY AND SPEECH CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUBATOV
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:509-430-1111
Mailing Address - Street 1:3940 LAUREL CANYON BLVD
Mailing Address - Street 2:SUITE 456
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-3709
Mailing Address - Country:US
Mailing Address - Phone:818-287-8875
Mailing Address - Fax:818-704-7898
Practice Address - Street 1:5217 ETIWANDA AVE
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4335
Practice Address - Country:US
Practice Address - Phone:509-430-1111
Practice Address - Fax:818-704-7898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 13829261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942364526OtherECA