Provider Demographics
NPI:1932711934
Name:MACIAS, ALVARO DANIEL
Entity Type:Individual
Prefix:
First Name:ALVARO
Middle Name:DANIEL
Last Name:MACIAS
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 1:8685 RIO SAN DIEGO DR APT 4344
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-6560
Mailing Address - Country:US
Mailing Address - Phone:909-486-8503
Mailing Address - Fax:
Practice Address - Street 1:8685 RIO SAN DIEGO DR APT 4344
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-6560
Practice Address - Country:US
Practice Address - Phone:909-486-8503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman