Healthcare Provider Details

I. General information

NPI: 1639723919
Provider Name (Legal Business Name): DAVID MACIAS CADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2598 WINDMILL PKWY STE 100
HENDERSON NV
89074-5476
US

IV. Provider business mailing address

2598 WINDMILL PKWY STE 100
HENDERSON NV
89074-5476
US

V. Phone/Fax

Practice location:
  • Phone: 702-248-0000
  • Fax: 702-933-5545
Mailing address:
  • Phone: 702-248-0000
  • Fax: 702-933-5545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00744-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: