Provider Demographics
NPI:1689388548
Name:MACIEL, ADAM MACIEL JESUS
Entity Type:Individual
Prefix:
First Name:ADAM MACIEL
Middle Name:JESUS
Last Name:MACIEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 RAFT LN
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-1769
Mailing Address - Country:US
Mailing Address - Phone:805-201-7976
Mailing Address - Fax:
Practice Address - Street 1:2600 RAFT LN
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93035-1769
Practice Address - Country:US
Practice Address - Phone:805-201-7976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093301848Medicaid