Healthcare Provider Details

I. General information

NPI: 1417280561
Provider Name (Legal Business Name): JAMES L MAESTAS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11421 PASEO DEL OSO NE
ALBUQUERQUE NM
87111-2666
US

IV. Provider business mailing address

11421 PASEO DEL OSO NE
ALBUQUERQUE NM
87111-2666
US

V. Phone/Fax

Practice location:
  • Phone: 505-299-6929
  • Fax:
Mailing address:
  • Phone: 505-299-6929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP00003997
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: