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Organization
LLPMG DESERT
Active
Organization
LLPMG DESERT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LIBERTY OLIVE MACIAS NP (CEO)
(909) 900-6465
Entity
Organization
Contact information
Practice address
81880 DOCTOR CARREON BLVD STE C202, INDIO, CA 92201-5587
(760) 922-7322
Mailing address
PO BOX 1303, LOMA LINDA, CA 92354-1303
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
NULL
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
NULL
103T00000X
Psychologist
—
—
106H00000X
Marriage & Family Therapist
—
NULL
106H00000X
Marriage & Family Therapist
—
—
2084P0800X
Psychiatry Physician
—
NULL
2084P0800X
Psychiatry Physician
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/31/2026
Last updated
07/31/2026
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