Healthcare Provider Details

I. General information

NPI: 1326337353
Provider Name (Legal Business Name): JOSEPH MACIAG HS3
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2011
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 CALLE LA PUNTILLA
SAN JUAN PR
00901-1818
US

IV. Provider business mailing address

COAST GUARD SECTOR SAN JUAN 5 CALLE LA PUNTILLA
APO AA
00901-0100
US

V. Phone/Fax

Practice location:
  • Phone: 787-729-4344
  • Fax:
Mailing address:
  • Phone: 787-729-4344
  • Fax: 787-729-2337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: