Provider Demographics
NPI:1346856077
Name:MACIAS, JOSHUA (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOSHUA
Middle Name:
Last Name:MACIAS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 9TH AVE UNIT 209
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-8939
Mailing Address - Country:US
Mailing Address - Phone:619-961-9386
Mailing Address - Fax:
Practice Address - Street 1:1441 9TH AVE UNIT 209
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-8939
Practice Address - Country:US
Practice Address - Phone:619-961-9386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58356225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty