Provider Demographics
NPI:1265470710
Name:MACIAS, MARGARITA RELOZA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:RELOZA
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 1:813 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3941
Mailing Address - Country:US
Mailing Address - Phone:575-622-2606
Mailing Address - Fax:
Practice Address - Street 1:813 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3941
Practice Address - Country:US
Practice Address - Phone:575-622-2606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061366174400000X
NMMD2009-0652208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM406815700Medicaid
NMI27194Medicare UPIN
NM326LK946Medicare PIN