Healthcare Provider Details

I. General information

NPI: 1215128327
Provider Name (Legal Business Name): DAISY MACIAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 MAGNOLIA AVE
RIVERSIDE CA
92505-3043
US

IV. Provider business mailing address

PO BOX 49
NUEVO CA
92567-0049
US

V. Phone/Fax

Practice location:
  • Phone: 951-353-2000
  • Fax:
Mailing address:
  • Phone: 951-223-1441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number72290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: