Healthcare Provider Details

I. General information

NPI: 1104965193
Provider Name (Legal Business Name): CARLOS MACIAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL PLAZA SUITE 660 UCLA CARDIAC ARRHYTHMIA CENTER
LOS ANGELES CA
90092-7392
US

IV. Provider business mailing address

1041 18TH ST 4
SANTA MONICA CA
90403-4421
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6433
  • Fax:
Mailing address:
  • Phone: 424-364-5630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2005-0248
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberHM274Z
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA119680
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA119680
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA119680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: