Basic Information
| Provider Information | |||||||||
| NPI: | 1043646490 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MACIAS | ||||||||
| FirstName: | ANA | ||||||||
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| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1160 N DUTTON AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954014652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075452700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1160 N DUTTON AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | SANTA ROSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 954014652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7075452700 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2013 | ||||||||
| LastUpdateDate: | 09/17/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2470A2800X | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Health Information | Assistant Record Technician |
No ID Information.