Healthcare Provider Details

I. General information

NPI: 1437053543
Provider Name (Legal Business Name): JUSTIN MACIAS EMT-B
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 415 BOX 8781
APO AE
09114-0088
US

IV. Provider business mailing address

PSC 415 BOX 8781
APO AE
09114-0088
US

V. Phone/Fax

Practice location:
  • Phone: 661-384-4551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE3086963
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: