Provider Demographics
NPI:1689029258
Name:MACIAS, MARIA ISABEL (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ISABEL
Last Name:MACIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 N MESA ST STE E
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3575
Mailing Address - Country:US
Mailing Address - Phone:915-533-8499
Mailing Address - Fax:915-544-4929
Practice Address - Street 1:7430 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3504
Practice Address - Country:US
Practice Address - Phone:915-779-7378
Practice Address - Fax:915-779-2822
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS1172207RS0012X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX409301502Medicaid