Provider Demographics
NPI:1114168887
Name:MACIAS, VELMA E (FNP)
Entity Type:Individual
Prefix:MRS
First Name:VELMA
Middle Name:E
Last Name:MACIAS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1775 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:CA
Mailing Address - Zip Code:95301-3608
Mailing Address - Country:US
Mailing Address - Phone:209-358-5611
Mailing Address - Fax:
Practice Address - Street 1:1775 3RD ST
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-3608
Practice Address - Country:US
Practice Address - Phone:209-358-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA438589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine