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General NPI Number Information
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NPI Number | 1871539130
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Entity Type | Individual
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Provider Name | EDUARDO PEDRO MACIAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 18066 FOOTHILL BLVD
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City | FONTANA
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State | CA
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Zip | 92335-8503
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Country | US
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Telephone | 909-427-8900
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Fax | 951-359-0550
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Provider Business Mailing Address
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Address Line | 18066 FOOTHILL BLVD
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City | FONTANA
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State | CA
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Zip | 92335-8503
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Country | US
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Telephone | 909-427-8900
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Fax | 951-359-0550
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A86739
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License Number State | CA
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