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General NPI Number Information
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NPI Number | 1740783026
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Entity Type | Organization
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Legal Business Name | LUIS H. MACIAS MD INC
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Dates
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Enumeration Date | 03/13/2018
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Last Update Date | 03/13/2018
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Provider Practice Location Address
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Address Line | 13924 MARQUESAS WAY APT 1524
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6018
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Country | US
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Telephone | 310-574-2103
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Fax | 310-640-6069
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Provider Business Mailing Address
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Address Line | 8605 SANTA MONICA BLVD # 91818
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City | LOS ANGELES
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State | CA
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Zip | 90069-4109
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Country | US
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Telephone | 310-574-2103
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Fax |
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Authorized Official
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Title or Position | TREASURER
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Name | HANS G MILIAN
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Credential |
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Telephone | 858-480-6772
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State | CA
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