Healthcare Provider Details

I. General information

NPI: 1063254878
Provider Name (Legal Business Name): ALDO MACIAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 CARPINTERIA AVE STE 2
CARPINTERIA CA
93013-1446
US

IV. Provider business mailing address

12038 W SHADOW LAKES ST
WICHITA KS
67205-3900
US

V. Phone/Fax

Practice location:
  • Phone: 805-684-4537
  • Fax:
Mailing address:
  • Phone: 805-890-5784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number62179
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number111386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: