Provider Demographics
NPI:1144533860
Name:HARGIS, MAXWELL B JR (HIS)
Entity type:Individual
Prefix:MR
First Name:MAXWELL
Middle Name:B
Last Name:HARGIS
Suffix:JR
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1582 W SAN MARCOS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4081
Mailing Address - Country:US
Mailing Address - Phone:760-599-0800
Mailing Address - Fax:760-599-0751
Practice Address - Street 1:1582 W SAN MARCOS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4081
Practice Address - Country:US
Practice Address - Phone:760-599-0800
Practice Address - Fax:760-599-0751
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 2815237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist