MEDICARE: JOSETTE M MACIAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	120141	OTHER	CA	SUBSTANCE ABUSE

General Provider Information

NPI Number	:	1003200676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSETTE M MACIAS

Provider Business Mailing Address
First Line	:	1153 N SAN ANTONIO AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-1803
Country	:	US
Telephone Number	:	323-327-8066
Fax Number	:

Provider Business Practice Location Address
First Line	:	1153 N SAN ANTONIO AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-1803
Country	:	US
Telephone Number	:	323-327-8066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2015
Last Update Date	:	05/29/2026

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Directions to “ JOSETTE M MACIAS ” Practice Location

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