Provider Demographics
NPI:1932224680
Name:MACIAS, FAVIOLA
Entity Type:Individual
Prefix:
First Name:FAVIOLA
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 1:725 E MAIN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2748
Mailing Address - Country:US
Mailing Address - Phone:805-933-8440
Mailing Address - Fax:805-933-0057
Practice Address - Street 1:725 E MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2748
Practice Address - Country:US
Practice Address - Phone:805-933-8440
Practice Address - Fax:805-933-0057
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical