MEDICARE: JEANETTE MACIAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	373H00000X	Day Training/Habilitation Specialist
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1235013004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE MACIAS

Provider Business Mailing Address
First Line	:	3303 N BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-2803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3303 N BROADWAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-2803
Country	:	US
Telephone Number	:	800-854-7771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2025
Last Update Date	:	02/26/2026

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Directions to “ JEANETTE MACIAS ” Practice Location

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