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General NPI Number Information
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NPI Number | 1609076504
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Entity Type | Organization
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Legal Business Name | DAVID M. MACIAS, M.D., PC
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Dates
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Enumeration Date | 07/19/2007
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Last Update Date | 07/20/2007
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Provider Practice Location Address
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Address Line | 1925 ROSINA SUITE D
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City | SANTA FE
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State | NM
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Zip | 87505-3355
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Country | US
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Telephone | 505-984-8206
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Fax | 505-984-8274
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Provider Business Mailing Address
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Address Line | 1925 ROSINA SUITE D
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City | SANTA FE
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State | NM
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Zip | 87505-3355
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Country | US
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Telephone | 505-984-8206
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Fax | 505-984-8274
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID M MACIAS
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Credential | M.D.
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Telephone | 505-984-8206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 76-228
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License Number State | NM
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