Provider Demographics
NPI:1255953345
Name:MACIAS, ANGIE (MD)
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:MACIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:844-630-0700
Mailing Address - Fax:877-374-1924
Practice Address - Street 1:1211B E CLIFF DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4734
Practice Address - Country:US
Practice Address - Phone:915-591-6226
Practice Address - Fax:915-308-9433
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2024-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXT9940207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine