Healthcare Provider Details

I. General information

NPI: 1669093639
Provider Name (Legal Business Name): LESLIE VICTORIA MACIAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 W INTERSTATE 10 STE 1500
SAN ANTONIO TX
78230-3883
US

IV. Provider business mailing address

8000 W INTERSTATE 10 STE 1500
SAN ANTONIO TX
78230-3883
US

V. Phone/Fax

Practice location:
  • Phone: 210-524-7747
  • Fax: 210-469-4026
Mailing address:
  • Phone: 210-524-7747
  • Fax: 210-469-4026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number878048
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number878048
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number878048
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number878048
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number878048
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number878048
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: