Provider Demographics
NPI:1790485282
Name:MACIAS, DONNA (BA)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:MACIAS
Suffix:
Gender:
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 N MOUNTAIN AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4173
Mailing Address - Country:US
Mailing Address - Phone:626-753-5296
Mailing Address - Fax:
Practice Address - Street 1:870 N MOUNTAIN AVE STE 220
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4173
Practice Address - Country:US
Practice Address - Phone:626-753-5296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker