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General NPI Number Information
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NPI Number | 1851763676
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Entity Type | Individual
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Provider Name | DESIRAE NICOLE MACIAS P.A
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Gender | Female
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Dates
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Enumeration Date | 10/21/2015
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 4911 WARNER AVE SUITE 205
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649
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Country | US
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Telephone | 714-316-0611
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Fax | 714-520-0087
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Provider Business Mailing Address
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Address Line | 4911 WARNER AVE SUITE 205
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649
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Country | US
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Telephone | 714-316-0611
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Fax | 714-520-0087
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 285
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 028264-01
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10772
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License Number State | AZ
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA3264
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License Number State | NV
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Taxonomy #5
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9119701
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License Number State | FL
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Taxonomy #6
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 52952
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License Number State | CA
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Taxonomy #7
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA52952
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License Number State | CA
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Taxonomy #8
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA0008942
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License Number State | CO
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