Healthcare Provider Details

I. General information

NPI: 1639735459
Provider Name (Legal Business Name): JESSICA ELIZABETH MACIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5078 BULLION ST
MARIPOSA CA
95338-2416
US

IV. Provider business mailing address

5078 BULLION ST
MARIPOSA CA
95338-2416
US

V. Phone/Fax

Practice location:
  • Phone: 661-204-5072
  • Fax:
Mailing address:
  • Phone: 661-204-5072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: