Provider Demographics
NPI:1639878051
Name:MACIAS, ADRIANA
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:MACIAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 S FLORE ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1817
Mailing Address - Country:US
Mailing Address - Phone:714-737-9361
Mailing Address - Fax:
Practice Address - Street 1:140 S CHAPARRAL CT
Practice Address - Street 2:SUITE 110
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-2239
Practice Address - Country:US
Practice Address - Phone:714-282-8852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36477235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist