Healthcare Provider Details

I. General information

NPI: 1972434637
Provider Name (Legal Business Name): PETER JAMES MACIEL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 N SUNRISE WAY
PALM SPRINGS CA
92262-5201
US

IV. Provider business mailing address

42837 ACACIA AVE
HEMET CA
92544-5118
US

V. Phone/Fax

Practice location:
  • Phone: 760-778-2210
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: