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General NPI Number Information
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NPI Number | 1932310745
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Entity Type | Individual
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Provider Name | REBECCA AMELIA MAESTAS PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 3436 ISLETA BLVD SW
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City | ALBUQUERQUE
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State | NM
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Zip | 87105-5837
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Country | US
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Telephone | 505-596-2300
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Fax |
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Provider Business Mailing Address
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Address Line | 538 N PASEO DE ONATE
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City | ESPANOLA
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State | NM
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Zip | 87532-2618
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Country | US
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Telephone | 505-753-7218
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0110002488
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1001380
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | AMD-396
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License Number State | HI
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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 | PA2024-0007
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License Number State | NM
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